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TRANSACTIONS

jHomceopatbic (T\eMcal Society

State of New York

FOR THE YEAR i£

VOLUME XXII.

FART I.

H0M0E0PATHie FR&DieAL SeeiETY

OF THE

STATE OF NEW YORK.

Proceedings of the Thirty-Fifth Semi-Annual Meeting, held at the
Cataract House, Niagara Falls, N. Y., on the 7th and

8th of September, 1886.

The meeting was called to order by the President, Henry C
Houghton, M, D., of New York City, who made a few felicitous
remarks, calling attention to the pleasant surroundings, the grandeur
of the location and the desirability of entering heartily into the spirit
of the scientific work before the Society.

The Kev. J. W. Brown, D. D., of St. Paul's Church, Buffalo,
N. Y., opened the session with prayer.

J. C. Nottingham, M. D., a delegate from the Homoeopathic Med-
ical Society of the State of Michigan, being ' present, was cordially
welcomed, and the privileges of the floor extended to him.

On motion of Dr. Hasbrouck, the courtesies of the Society were
tendered to all visiting physicians present.

Drs. Wright, Paine and Hasbrouck were appointed the committee
on credentials.

The committee on credentials subsequently reported the following
members, delegates and visitors present :

Drs. H. M. Paine, Albany Co.; F. E. Murphy, Cayuga Co.; A. H.
Babcock, Chautauqua Co.; Ermina C. Eddy, Sarah Eddy Thorn,
.Chemung Co.; A. R. Wright, J. D. Heinemann, Geo. W. Lewis, Jr.,
Joseph W. Cook, S. N. Brayton, L. A. Bull, F. Park Lewis, Erie Co.;
John L. Moffat, E. Hasbrouck, A. von der Liine, L. Safford Gillespie,
Kings Co.; G. T. Borden, Livingston Co.; J. M. Lee, II. M. Dayfoot,
Edwin II. Wolcott, Sarah I. Lee, W. P, Fowler, W. F. Clapp, Monroe
Co.; Henry C. Houghton, Fred. S. Fulton, New York Co.; Fredk.

v- 1

4 Proceedings.

Letur^nlut^er, < >noi<,H r °» A - J * Frantz, Seneca Co ; B. F. Grant,
SftMiiI vn Co.: J. W.Coolidge, Scranton, Pa.; J. R. Simson, Tonawanda,
N Y ; J«»Iiii<\ Nottingham, Bay City, Mich ; M. E. Sherman, Castile,
N \ ; A. 4. Kvans, Lockport, X. Y.; J. W. Hodge, Niagara Falls,

Uv.u' v ^»* from the societies of New York and Kings counties
*% u usviwh! ivgarding the laws regulating the practice of medicine
m V '\\ \ v»i k State.

On moiioii, referred to the Committee on Legislation.

Kb. PORT OF THE BUREAU OF MATERIA MEDICA.

Tlu; rh.iirman, T. F. Allen, M. D., being absent, the bureau report
w.i.. pri'ni'iitiHl by Dr. E. II. Wolcott.

REPORT OF THE BUREAU OF HISTOLOGY.

Oia.n, McDowell, M. D., Chairman, being absent, Dr. Geo. W.
Lk\u«. Ju., presented a paper on the "Bacillus of Typhoid Fever."

REPORT OF THE BUREAU OF OBSTETRICS.

K\ hiRi'rr IIasbrouck, M. D., Chairman. The following papers were
nrt men ted : " Albuminuria of Pregnancy :" Its Causation, Dr. W. M.
Ulackiimu ; Its Effects, Dr. Win. A. Allen; *Its Treatment, Dr.
Uoorge W. Winterburn.

" ( Complications of Parturition (Part II.), Pelvic Dystocia," Dr. II.
J. Piorron.

" A Perplexing Case of Parturition," Dr. R. C. Moffat.

"The Use of Anaesthetics in Parturition," Dr. F. E. Murphy.

Adjourn.

AFTERNOON SESSION.

Society convened at 3 p. m. First Vice-President, F. Park Lewis,'
M. D., in the chair. The consideration of the report of the Bureau
of Obstetrics was continued until 4:30 p. m., when the Society
adjourned for the purpose of making a trip to Lew T iston.

— • - - *-v title.

Thirty-Fifth Semi-Annual Meeting.

EVENING SESSION.

Society called to order at 8:30. First Vice-President, F. Park
Lewis, M. D., in the chair. The President, Henry C. Houghton,
M. D., delivered the following address on " The Medical Ethics of the
Use and Abuse of Alcohol " :

Members of the Homoeopathic Medical Society of the Stzte of
New York :

Ladies and Gentlemen :

It is required of your presiding officer, that lie deliver at this time
an address, and the unwritten law leads you to expect one of, a popular
character, so if I fail to make it so in the ordinary sense, I have tried
to make it so in a broader sense, for the theme touches every person
present, every member of the society present or absent, every medical
man or woman who stands between the living and the causes of death.
My subject is, The Medical Ethics of the Use and Abuse of Alcohol.

The praises of the wine cup have been sung in poetry and rung in
prose, from the time that Noah succumbed to its seductive and
voluptuous ecstacy. What was true then, is true now, and it is absurd
to deny the plain fact, that this appeal to the senses is the secret of the
hold which alcoholic beverages have upon the human race ; in it man
has found stimulus to extraordinary effort, and temporary release
from the ills of life, this stimulus, and this release, being secured by
the risk of penalties which the genius of a Shakespeare fails to portray.

What is use, and what is abuse in the consumption of alcohol ? . The
right solution of the question involves interests that are most
momentous. It affects not only the individual consumer, but bears
upon community interests, menaces the peace of the State, and through
the State the life of the Nation itself Twenty-five years ago we were
confronted with a problem which involved the liberty of four millions
of people, and the unity of this government ; two sections of the
country faced each other in mortal combat, and for four years the
world looked on, questioning the probable issue To day we are on
the possible verge of a national struggle more liable to disintegrate the
national body, because the forces are local, not sectional ; every labor
interest, every investment of capital, all social and political issues, are
involved, and may at any moment be dominated by forces well nigh
irresistible. It is not my purpose to burden you with statistics ; but
you will admit a few to show the possibilities of the future.

6 Proceedings.

By reference to the national returns it is seen that in 1873, 364,471,-
672 gallons of alcoholic liquors were sold at a cost of $714,196,517 ;
ten years later the amount rose to 610,195,505 gallons, at a cost of
$944,629,531—69,000,000 increase in one year. *Gustafson gives the
figures for the United Kingdom as over £130,000,000, and the expense
and loss resulting from drink to be much more. What is the sig-
nificance of these figures? Deduct the amount actually used in
mechanical, chemical and medicinal arts, and we see that the great bulk
of this wealth is consumed by our people as stimulating drinks.

A careful student of the statistics of the census reports, Wm. Har-
graves, M. D., says, during the present century (eighty-four years) we
have spent for liquors $21,286,000,000, or $3,081,000,000 more than
all foreign import during the same period, and $4,964,200,000, than all
domestic exports. Thus have our people been continually spending,
since the formation of the nation, more than the value of imports or
exports ; similar comparisons may be drawn between assessed value of
real and personal property, food products, results of mechanical
industry, etc., all in favor of alcoholic products, and against the
anarchist's cry that he is deprived of his labor.

These figures may serve to prepare us for our second inquiry. What
is the value of these products in the human economy ? This can only
be answered by a study of its action. Alcohol is a narcotic stimulant,
its action is similar to other agents of its kind, having its individual
peculiarities, and this action must be studied under two heads. First,
physiological; second, pathological. If by physiological we understand
such action as is not characterized by abnormal phenomena or perma-
nent tissue change, it must be admitted that this sphere of action must
be very limited, for it is true that while some subjects may use large
quantities of alcohol without apparant injury, others are seriously
affected by very small amounts ; hence the ground where physiology
shades into pathology is more or less undefined.

Like other ethereal compounds such as chloroform, sulphuric ether,
amyl-nitrate, etc., or like vegetable narcotics, the action of alcohol
may be studied in two stages, excitation and depression, and it will be
found that the axiom " action and re-action are equal and in opposite
directions v holds true as in natural philosophy. Immediately after
the ingestion of alcohol the phenomena of excitation begin, and are
more or less marked in character, or prolonged in duration, according

*Gustafson, Alex. Foundation of Death, London, 1884; Boston, 1885. I am indebted to
this author for a research which it was impossible for me to make in the time at ray disposal.
His bibliography on the subject is the most complete, and his work the most comprehensive
and impartial, that I have ever had in hand.

Thirty-Fifth Semi-Annual Meeting. 7

to the form of liquor used : this action is primary, immediate, upon
the great nervous centres, so prompt that some claim that it is due to
inhalation, or direct transmission into the systemic circulation. The
action is also secondary, indirect, by digestive and assimilative pro-
cesses : its effects extend to every organ of the body. It is not my
purpose to enlarge upon this well-known subject : suffice it to say that
the various functions of the body are all involved, and are for the time
apparently more active. If the dose is not repeated the effects
gradually cease, and the ordinary functional conditions are resumed ;
if the dose is repeated it is soon observed that in order to obtain all
the marked symptoms of stimulation, as promptly as at the first, the
dose must be increased : this is so until we are on the debatable ground
of pathology.

Without stopping to debate the mooted question, Is stimulation
simply a fine shade of the later narcosis and paralysis ? or to inquire
into the why or the how of the symptoms noticed under a limited use
of alcohol, let us hasten to what more nearly concerns us.

The pathological results of alcohol are now well recognized by us ;
so there is little difference of opinion as to the relations of the cause
and effect. Life is the resultant of two processes : constructive and
destructive metamorphosis ; if either ceases, death ends all, first locally,
then generally ; hence we may follow these two lines, and consider
those functions which furnish building material, and those which
remove the waste. The digestive and respiratory functions may stand
for the first; the functions of the liver, kidneys, skin and the ex-
cretory acts of the lungs, for the second, aided by muscular action, and
presided over by the cerebro-spinal and sympathetic system. The acts
of assimilation and circulation, are the connecting links between supply
on one hand, and waste on the other, the tissues of the body constitute
the field where the issues of life are waged.

The apparent conflict of facts in gastric digestion, when alcohol is
given, were explained by Dr. Beaumont in his experiments on St.
Martin : the increased activity, sense of warmth and comfort, are due
to the hyperemia caused by the alcohol. The later retarded digestion,
is due to the precipitation of the peptin ferment.

It is surprising to note the amount of derangement, even to ex-
travasation that may occur, and very little discomfort be manifested
by the subject.

There is one gastric symptom that has been the cause of popular
misconception, because it is systemic, rather than gastric : I mean the
intense thirst caused bv alcohol. Even Mrs. Partington misunderstood

8 Proceedings.

Ike's condition and insisted that he never took anything to drink when
he was out late at night, because he was so very thirsty the next
morning. Alcohol has great affinity for water, and undiluted, will take
it from the fluids of the mouth or stomach ; later, when carried into
the general circulation, the draft is on the water in the tissues : hence
the demand we call thirst ; it is puerile to claim that such outcry is a
demand for alcoholic stimulant ; exhaustion may have made the first
call for stimulant ; the second call is equally unnatural.

Similar derangement of intestinal digestion is noticed, due to the
same cause affecting the mucous membrane and viscera secreting the
intestinal fluids ; all are affected until they fail to meet the demands of
normal life, and require abnormal stimulation : here lies danger.

The respiratory function is so intimately linked with that of circu-
lation that it is hard to separate what is popularly termed "rum
consumption " into its factors. The lungs fail because the circulation
is faulty, the circulation fails because the vaso-motor force is low, and
the vital energies flag because the blood is improperly, imperfectly
aerated ; so the curse is moved around the circle. Dr. B W. Rich-
ardson, writing of this condition, says : " For many years these
sufferers, owing to a splendid conformation of the body, may live
apparently uninfluenced by any disease, in which respect they differ
from alcoholics generally, and in fact are instanced by votaries of
Bacchus, as men who drink deep and seem never worse for drinking.
This wonderful health is however, after all, apparent only. Ques-
tioned closely, it is soon discovered that these victims have long been
out of health ; that a slight influence such as a cold has easily depressed
them, that, subjected to unusual excitement or unusual fatigue, their
balance of strength against exertion is weakened, and that an extra
quantity of alcohol has often been wanted to bring them up to their
required activity. Nevertheless they pass for healthy men ; they look
healthy, and retain their good looks to the last. * * * * There
is no remedy whatever for alcoholic phthisis ; it may be delayed in its
course, but it is never stopped, and not nnfrequently, instead of being
delayed, it runs to a fatal termination more rapidly than is common in
any other type of disorder."

Such are the statements of one fitted to give judgment. Turning
now to consider the effects of alcohol upon those organs which
eliminate the waste from the system, the liver is of the first impor-
tance, because upon it more than any single organ depends the
completion of the eliminative process : the entire volume of blood
from the abdominal circulation, passing through its structure and
there freeing itself from a load of effete material.

Thirty-Fifth Semi- Annual Meeting. < 9

Dr. Richardson writes thus: "The organ of the body which most-
frequently, perhaps, undergoes structural changes from alcohol is the
liver. The capacity of this organ for holding active substances in its
cellular parts is one of its physiological distinctions. In instances of
poisoning by arsenic, antimony, strychnine, and other poisonous com-
pounds, we find in conducting our analysis, the liver to be, as it were,
the central depot of the foreign matter. It is the same practically in
poisoning with alcohol. The liver of the confirmed alcoholic is prob-
ably never free from the influence of the poison, it is often saturated
with it." Exception cannot be taken to these statements ; the term
44 hob-nailed " has a well understood significance, being the synonym
for " gin-drinkers' liver," L e., the organ has lost its cellular parts,
hence the term 44 contracted " ; the pathological condition explains the
dropsical symptoms, they arise because the return circulation is checked
by the contracted state of the hepatic structures.

A similar state of tissue change occurs in the kidneys. Loss of the
soft parts by fatty degeneration interferes with the relation of the
blood vessels and excretory structures, so that the relation between
salts, albumen, and water, cannot be maintained ; the body wastes,
being drained of material needed in tissue building, and the patient is
6aid to have 44 Bright's disease," even by those who are unable to make
technical distinctions. Nature has hung out her danger signals that
are recognized by experts in ophthalmoscopy, and by microscopists ; the
patients disregard them at their peril.

When we come to the 6tudy of the nervous system for localized
symptoms of the abuse pf alcohol, we have forced upon us the truth
that if one member suffer, all the members suffer with it. It ia
claimed by some, that the most direct, most powerful effect of alcohol,
is upon the brain and general nervous system, ganglia and ramifica-
tions, so that the changes in special organs are due to loss of nervous
energy and inability to resist the effect of alcohol upon their structures.
The special senses are dulled, as can be shown by careful tests made
before and after its use ; a similar narcosis is produced upon the entire
system, so that we have the local effect upon remote organs added to
the centric effect of diminished nervous energy. Although the effecta
upon the nervous system are general, yet it is true that local lesions,
causing paralysis of lower or upper extremities, occur more frequently
in alcoholized subjects, because its force is added to predisposing
causes.

Not only is alcohol the direct cause of the conditions hist consid-
ered, but expert testimony, both here and abroad, is unanimous that it

10 Proceedings.

is a principal predisposing cause of insanity, the only point of differ-
ence being the percentage allowed. Gustafson quotes authorities as
follows :

Dr. F. Ganghofner, of Prague, say6, " It is estimated that in the
asj^ums of America, England, and Holland, the total number of
insane, from drink, ranges from 15 to 20 per cent, and from 20 to 25
per cent, in the asylums of France."

The third report on intemperance before the select Committee of
the House of Commons shows from 1865 to 1875 an increase in popu-
lation of 14 per cent, and in drunkenness of 130 per cent.

Mr. Hoyle 6tates that the number of lunatics in asylums and work-
houses in the United Kingdom, will be slightly over 100,000, besides
many not in asylums. In England and Wales in the year 1860 there
were 38,038, but in 1880 they had increased to 79,191, being nearly
double, although the population had increased only 28 per cent.

W. J. Corbet, in a striking paper entitled, Is Insanity on the
Increase ? {Fortnightly lieview, 1884,) says, "After being engaged for
many years, and under special circumstances, in studying the statistics
of insanity I have reluctantly come to the conclusion that facts and
figures establish clearly the progressive growth of the malady. * *
It would only be wearisome to enter more fully into statistical details,
any one that wishes, and has leisure, can scrutinize for himself. The
plain fact stands out, however others may try to disguise it in words,
that in the brief course of two decades the insane in the kingdom have
nearly doubled in number, in spite of the most elaborate and costly
means provided to cure them. There is, moreover, another alarming
feature, in that we evidently do not yet know the worst. The ominous
words ' inadequate accommodation ' and 4 increase of provision ' run
through the whole series of reports from beginning to end."

Gustafson quotes from the report to the Belgian Chamber of Repre-
sentatives by the Minister of Instruction (Brussels, 1868), in which
the following facts are given as the drink results for England :

(1.) Nine-tenths of the paupers of whom, according to Hoyle, there
were over three and a half millions in 1881. (2.) Three fourths of
the criminals. (3.) One-half of the diseases. (4.) One third of the
insanity. (5.) Three-fourths of the depravity of children and young
people. (6.) One third of the shipwrecks. He quotes American
authorities as follows : Dr. Lee, of Philadelphia, in Report on
Insanity (1868), gave for the year 1860, one insane person to every
1,305 inhabitants, and in 1868, one to every 700. In his u Insanity
and Insane Asylums" (Sacramento, 1872), Dr. E. T. Williams, Com-

Thirty- Fifth Semi-Annual Meeting. 11

missioner in Lunacy for the State of California, states (p. 211) that it
is his opinion intoxication is a far mightier cause of mental diseases
than all other causes put together, and then adds : " The last United
States census shows that there has been a most alarming increase in the
number of lunatics and idiots ; during the last decade, while the popu-
lation has increased by 20 per cent., the increase of the insane is given
as a little over 155 per cent."

If the consequences of wrong action ended with the individual, the
case would be bad enough, but it is a sad fact that the reproduction of
the species gives a line of heredity, that goes on not only to the third
and fourth generations, but to an extent not possible to measure, till
one does not wonder that the proposition to have criminals deprived
of the power to reproduce their kincf, has been proposed in essays
written by those having the largest experience in our public institutions.

Harsh as this may seem, it is only anticipating the course of nature,
for Professor Kraft, in Psychiatrie (Stuttgart, 1883), quoted by
Gustafson, shows how nature disposes of generations of drunkards.
First generation — moral depravity, alcoholic excess; second genera-
Hon — drink mania, attacks of insanity, general insanity ; third
generation — hypochondria, melancholic apathy and tendency to murder ;
fourth generation — imbecility, idiocy, and extinction of the family."

Mr. Cabot previously quoted, after referring to a statement of Lord
Shaftesbury, to the effect that intemperance is the cause of fully two-
thirds of the insanity that prevails, either in the drunkards themselves
or their children ; also to one made in an address in the House of
Lords to the effect that fully six -tenths of all the cases of insanity to
be found in these realms and in America arises from no other cause
than intemperance, goes on to say, " I go a step further, and hold that
there is abundance of evidence to prove that to dissipation, drunkenness,
and moral depravity, either directly or consequentially by transmission
to the next generation, is to be charged an immense proportion of the
annual increase of lunacy. No person of authority will be found to
deny that evil and corrupt living in the parents, bears fruit of an
unhealthy state of both body and mind in their offspring. In the lower
animals the transmission not only of generic qualities, but even of indi-
vidual singularities, is a similar fact ; so with mankind it is not to be
expected that a pure stream will issue from a polluted source ; and how
foul and corrupt that source must be any one who sees the habits of
the swarms of unfortunate creatures who nightly crowd the streets of
our great cities may determine for himself. * * * * It is said
that people now-a-days are impatient of restraint and betray a tendency

12 Proceedings.

to abandon all attempt at self discipline and to yield to every impulse
good or bad. If true, it is sad indeed, for it is, and from time imme-
morial has been, an indication of national decay. The great empires of
old perished not from sudden and violent convulsions, but from the
moral degradation of these people from internal rottenness, amounting
to national insanity. Quern deus vult perdere primus dementat"

In view of these sad effects of alcohol where shall we draw the line
between the use and abuse ? The lirst declaration on this subject, as
given by Gustafson, was drawn up by Dr. Julius Jeffreys, in 1839, and
signed by Sir Benjamin Brodie, and seventy-eight leading practitioners
of medicine and surgery. The following sentences show their view of
this theme : " An opinion handed down from rude and ignorant times,
and imbibed by Englishmen from their youth, has become very gen-
eral, that the habitual use of some portion of alcoholic drink — as of
wine, beer or spirit — is beneficial to health, and even necessary to those
subjected to habitual labor. Anatomy, Physiology, and the experience
of all ages and countries, when properly examined, must satisfy every
mind, well informed in medical science, that the above opinion is alto-
gether erroneous. Man in ordinary health, like other animals, requires
not any such stimulants, and cannot be benefited by the habitual
employment of any quantity, large or small ; nor will their use during
his life time increase the aggregate amount of his labor. In whatever
quantity they are employed they tend rather to diminish it. When he
is in a state of temporary debility from illness, or other causes, a tem-
porary use of them as of other stimulant medicines may be desirable ;
but as soon as he is raised to his natural standard of health, a continu-
ance of their use can do no more good to him even in the most mod
erate quantities ; while larger quantities (yet such as by many persons
are thought moderate) do, sooner or later, prove injurious to the human
constitution without any exception."

In this connection let me give you the indication for the use of alco-
hol, cited from the standard authorities :

Stille says that " alcohol is the usual and familiar remedy for debility,
shock, or fatigue, and syncope ; in typhus and typhoid fever, in pyae-
mia, relapsing fever, and diphtheria. That it should never be allowed
to produce intoxication even by abnormally exciting, still less by stupe-
fying."

Wood gives similar indications, and adds : u In chronic diseases great
care is necessary in the exhibition of the remedy, for fear of begetting
intemperate habits. This is especially the case in neuralgia, and other
painful affections, in which the narcotic influence of alcohol may be

Thirty-Fifth Semi- Annual Meeting. 13

very soothing ; under these circumstances there is a constant tendency
to an increase of the frequency and size of the dose. Taken habit-
ually in excess, alcohol produces the most deplorable results, and is a
very common cause of fatal maladies."

What has been the practice of the profession in the matter of alco-
holic liquors ? This question lias been forced upon my attention dur-
ing the past ten years by my relations in one of the institutions of the
city of New York, established for the reformation of the intemperate,*
and I am compelled to believe that the administration of alcohol has
been characterized by a recklessness which would be criminal if it were
less thoughtless ; there has been a happy -go-luck, off-hand prescription
of alcohol, as the easy, natural, inevitable 1 stimulant ; the form, the
amount, the frequency of the dose being left to the patient !!! Not
only so, but this has been done without the question, or the thought of
the patient's previous poisoning with alcohol. Many reformed men
have relapsed under the mistaken or careless advice of the family phy-
sician. It is wrong, it is cruel, to throw the responsibility on the
patient ; his moral sense is weak, his will is weaker still, and his medi-
cal adviser, therefore, cannot shift the responsibility from himself to
his patient. But a better day is at hand, a greater degree of caution is
now exercised by our more thoughtful and conservative practitioners.

Allow me to reinforce my own remarks by those of older and wiser
men. Gustafson quotes an article written by Dr. McMurtry, of Bel-
fast, in 1871 ; the following paragraphs are of interest in this connec-
tion :

" The ignorance of the people, encouraged as it has been by the atti-
tude of the medical profession toward the temperance movement, with
regard to the nature, properties, and real value of alcoholic drinks, has
constituted hitherto an almost impregnable barrier to the progress of
truth on this subject. Medical practice, and medical teaching, and per-
haps medical science altogether, have begotten and fostered the popu-
lar belief that alcohol is one of the good creatures of God. The med-
ical profession is responsible for the originating and perpetuating of
the great mistake that alcohol is a wholesome thing.

The people's medical advisers either teach by precept and example
that they are not injurious, or manifest an indifference to the evils pro-
duced by their use, which implies that they do not think them injurious.

It matters little whether it is what they teach, or what they do not
teach, that is the cause of popular belief and popular custom, for med-
ical men are just as responsible for its consequences, because it is their

*New York Christian Home for Intemperate Men.

14 Proceedings.

special province and privilege to diffuse that light and knowledge which
alone conld prevent them. For to whom can the temperance move-
ment look, to whom should it look for aid in exposing this pernicious
falsehood, but to the medical profession ? To whom else should a com-
munity suffering from the physical consequences of a physical poison
appeal, not only for their cure, but for their prevention ? Apart from
the absolute duty of every man to abstain from the unnecessary use of
a poison, it is preeminently the duty of medical men, who are natur-
ally and justly considered guides in all that pertains to the preservation
of health, to see that the powerful influence of their example is on the
side of virtue and sobriety. Their superior knowledge of the poison-
ous nature of alcohol implies a greater obligation to abstain from it ;
but it is their stronger and wider influence which, in an especial man-
ner, lays them under a deeper responsibility to set the people a safe
example in this matter, and incurs upon them a deeper guilt if their
example leads the people astray. Hence, I maintain that it is the duty
of medical men either (1) to disown alcohol altogether, on the strength
of a verdict which a large proportion of the profession — not to men-
tion competent judges outside the profession — have pronounced it ; or
else (2) to examine the matter for themselves with an earnest and sin-
cere desire to know the truth, considering the incalculable evils which
so many truthful, unprejudiced, and thoroughly qualified men attri-
bute solely to the common and medicinal use of alcohol (such use being
founded on false notions of the nature and real value of the drink). I
hold that it is the bounden duty of all who are in any degree responsi-
ble for the use of it, to give the whole subject that honest and atten-
tive consideration which its importance demands. This would be a
more philosophic, honorable, and philanthropic course to pursue than
that so often adopted by medical men, of refusing either to study the
question for themselves, or to be instructed by those who have studied
it. I should have thought that if no other or higher consideration
were sufficient, the honor of their profession would be enough to
arouse then- to defend it from the serious charge of contributing,
either knowingly or in wilful ignorance, to the miseries of the human
race.

" But suppose that after having given the subject the necessary inves-
tigation, they still believe that alcohol is an indispensable article of the
Materia Medica, what then ? What if some medical men have actually
done so, and have been forced to the conclusion that alcohol is a useful
food and a necessary medicine ? Then I tell them that it is their duty
(?>) to choose the lesser of the two evils. Prescribe alcohol, either diet-

Thirty-Fifth Semi-Anncal Meeting. 15

ically or medicinally, and you frequently create or resuscitate, and always
run a risk of creating or resuscitating, supposing the patient survives, au
uncontrollable and ultimately false appetite for intoxicating drink.
Thus, in your desire to cure one disease, which many believe could be
cured more certainly and safely by other means, you administer a rem-
edy which may and often does produce another disease of a much more
serious character, inasmuch as it involves not only physical, but moral
injury to the patient, and untold misery to his friends.

" You also give use to and confirm that widespread faith of the neces-
sity for, and remedial powers of, alcoholic liquors, which I have said is
at the very basis of the drinking customs, and is the remote origin of the
traffic itself and all its evils. For while I do not say that all who drink,
do so because they think the drink in good for them, I do say that they
all began to drink ignorant of the fact that alcohol is inherently and
essentially bad for them, and this ignorance is the result of the prescrip-
tion and recommendation by medical men of the various intoxicating
productions of the brewer and the distiller. And remember that the ad-
vocate of alcohol can claim no especial advantages for the alcoholic treat-
ment, which are not also claimed to a superior degree for the non-
alcoholic treatment, by those who have expunged the agent from their
list of remedies altogether."

This article was influential in leading to a declaration as suggested by
the British Medical Journal, which was signed by two hundred and
fifty-nine of the English physicians and surgeons. I quote it :

" As it is believed that the inconsiderate prescription of large quan-
tities of alcoholic liquids by medical men, for their patients, has given
use in many instances to the formation of intemperate habits, the
undersigned, while unable to abandon the use of alcohol in the treat-
ment of certain cases of diseases, are yet of opinion that no medical
practitioner should prescribe it without a sense of grave responsibility.
They believe that alcohol, in whatever form, should be prescribed with
as much care as any powerful drug, and that the directions for its use
should be so framed as not to be interpreted as a sanction for excess, or
necessarily for the continuance of its use when the occasion is past.

" They are also of the opinion that many people immensely exagger-
ate the value of alcohol as an article of diet, and since no class of men
see so much of its ill effects, and possess such power to restrain its
abuse, as members of our own profession, they hold that every medi-
cal practitioner is bound to exert his utmost to inculcate habits of great
moderation in the use of alcoholic liquids.

" Being also convinced that the great amount of drinking of alcoholic
liquors among the working classes of this country is one of the greatest

16 Proceedings.

evils of the day, destroying, more than anything else, the health, happi-
ness, and welfare of these classes, and neutralizing to a large extent the
great industrial prosperity which Providence has placed • within the
reach of this nation, the undersigned would gladly support any wise
legislation which would tend to restrict within proper limits the use of
alcoholic beverages, and gradually introduce habits of temperance."

This paper caused great excitement and led to some hot words.
Gustafson says, and this from the Pall Mall Gazette, has no uncertain
sound : —

" Although there are those who express indignation at the assumption
that alcohol is ever prescribed inconsiderately in large quantities, or
that sufficient care is not always taken to cut it off at the right moment,
and to arrest subsequent habits of induced tippling, there are too many
well-known examples of habitual evil induced by medical prescription
to make us hesitate to accept the declaration in every word, and in all
its meanings."

If such a manifesto was called for fifteen years ago, it is more in
demand just now, in view of the prominence which the question is
taking in all public affairs. Let me quote a few paragraphs from the
code of ethics of the American Institute of Homoeopathy, which has
been adopted as our expression of ethical relations.

u Section I. — The physician should hold himself in perfect readiness
to obey the calls of the sick. He should ever bear in mind the sacred
character of his calling, and the great responsibility which it involves,
and should remember that the comfort, the health, and the life of his
patient, depends upon the skill, attention and faithfulness with which
he performs his professional duties.

" Section II. — In no other profession should a higher standard of
morality, and greater purity of personal character, be required. Physi-
cians ought to come up to this standard, and do all they can to exalt it.
As the practice of medicine requires the constant exercise of a vigorous
and clear understanding, and as the practitioner should be, at all times,
ready for any emergencies in which the life of a fellow creature may
depend upon his steady hand, acute eye, and unclouded brain, it is in-
cumbent upon the physician to be temperate in all things.

" Section IV. — * * * For the physician should always bear
in mind that the great object of his profession is to cure the sick, and
that it is not only admissible, but it is his solemn duty to investigate,
thoroughly and without prejudice, whatever offers any probability of
adding to his knowledge of the art and means of curing, and of thus
enriching the science of medicine.

Thirty-Fifth Semi- Annual Meeting. 17

" Section V. — As good citizens it is the duty of physicians to be
vigilant for the welfare of the community, and to bear their part in
sustaining its institutions and burdens. They should always be ready
to give counsel to the public in relation to matters appertaining to their
profession, as for example on subjects of medical police, public hygiene,
and legal medicine."

This Society has adopted the foregoing language as our expression
of ethical views. They were from the pen of the late Carrol Dunham,
M. D., they harmonize with and enforce our theme, as if written for
the purpose. If we emulate the spirit of our honored teacher and
exemplar, we shall weigh well the considerations presented to you to-
day, they are the spirit of benevolence, the spirit of good will to our
fellow men.

We have less need to use alcohol than those of opposite views of the
practice of medicine, for we know that every properly selected remedy
is a stimulant, in the broadest sense ; but I fear there is a tendency to
forget the master, to resort to expedients, such as alcohol, to be satisfied
with diagnosis, to prescribe for diseases instead of conditions, as indi-
cated by symptoms. For these reasons we shall fail of the laurels won
by those who forced upon the profession a milder practice than that
which was once dominant.

In view of this code of ethics which we adopt, let me appeal to you
to give it a personal, as well as an organic endorsement, by example,
by teaching, by private and public protest against the drinking customs
of the times, do all that is in your power to arrest the tide of intem-
perance that threatens our beloved America and the w r orld. I live in
the hope, yes, the confident anticipation of the time when the public
mind shall be so educated to the fact that alcohol is a narcotic poison,
that the alcohol drinker shall be under the same ban as the opium
eater ; that alcohol shall no longer be sold in saloons, over the bar, but
its sale shall be restricted to the hands of responsible druggists, who
shall, by the same educated public sentiment, be held subject to public
censure for any and every known malfeasance of its issue, as they are
now adjudged regarding the sale of opium, or any other narcotic poison
for similar purpose.

A vote of thanks to the speaker w r as unanimously adopted.

Moved by Dr. Lee, seconded by Dr. Wolcott, that a committee of
three be appointed to report at morning session on advisability of
printing the President's address.

Carried.

1* PfcM_tfcl»IX«— .

Dk*. Lee. Ha^bkock and W«ji> ■ tt w^re ap{»:rited »ueh a com-
mittee.

On motion, Dk. JIa>broick read a paper entitled - Homoeopathic
Periodicals arid Medical Advertising/*

REPORT OF THE BUREAU OF GYNAECOLOGY.

A. It. Wkioht. M. D., Chairman, presented the following paper:
" A Plea for Total Extirpation of the Cancerous Interns Under Con-
ditions" of which he wa* the anthor.

REPORT OF THE BUREAU OF SURGERY.

Tjios. D. Spexcek, M. D., Chairman, being absent through sickness,
the papers of lib bureau were presented by Dr. J. M. Lee. The first
paper, "The Treatment of the Pedicle in Hysterotomy." by Dr.
II. I. Ostroin, was read bv title.

On motion, further consideration of this bureau was deferred until
the morning session.

The Society then adjourned until 9 a. m. Wednesday.

SECOND DAY.

Society called to order by First Vice-President F. Park Lewis, M. D.

lie port of Bureau of Surgery continued. The following papers were
presented : " Observations on the Medical and Surgical Treatment of
Tumors and Cancers of the Breast/' Dr. M. O. Terry, "Mam-
mary Tumor. Was it Schirrus f" Dr. R. C. Moffat, "Mammary
Tumors " — Clinical Cases, Dr. George Allen.

REPORT OF COMMITTEE ON PRESIDENTS ADDRESS.

The Committee on President's Address recommended that it be
published in monograph form, the expense thereof to be defrayed by
voluntary subscription. Also, that the address be published in the
following journals :

The Clinique, North American Journal of Homoeopathy,
Physician*' and Surgeons' Investigator and The Clinical Review.
Keport accepted and committee discharged.

Thirty-Fifth Semi-Annual Meeting. 19

On motion, a cominmittee consisting of Drs. Wolcott, Lee and
Wripht were appointed to solicit contributions. The committee
subsequently reported that the amount of $22.00 had been collected.

REPORT OF THE BUREAU OF OPHTHALMOLOGY.

Chas. F. Sterling, M. D., Chairman, being absent, Dr. F. Park
Lewis presented a paper on the u Treatment of Senile Cataract."

REPORT OF THE BUREAU OF OTOLOGY.

Wm. P. Fowler, M. D., Chairman. In the absence of the Chair-
man, Dr. Moffat presented a paper on " Treatment of Eczema of the
Ear," by Dr. Fowler.

REPORT OF THE BUREAU OF MENTAL AND NERVOUS DISEASES.
Samuel Lilienthal, M. D., Chairman. {No papers.)

REPORT OF THE BUREAU OF PiEDOLOGY.

Gertrude Goewey-Bishop, M, D., Chairman. In the absence of
the Chairman, the following papers were presented by Dr. Moffat :
" Marasmus Infantum " — Dr. Susan S. McKinney ; " A Question,
or Eczema Capitas," by Dr. S. Catherine Martineau ; " Summer
Complaint," by Dr. J. E. Slaught.

REPORT OF THE BUREAU OF LARYNGOLOGY.

George M. Dillow, M. D., Chairman. {No papers.)

REPORT OF THE BUREAU OF CLIMATOLQGY.

H. M. Paine, M. D., Chairman. " Purification of Water," by
Dr. George Allen.

Dr. Paine, of Committee on Legislation, reported the following
resolution, which was adopted :

Resolved, That the Homoeopathic Medical Society of the State of
New York endorses the proposition made by the Medical Society of
the State of New York, as set forth by its committee on legislation,
and presented to the recent session of the State Legislature, under
Senate bill 485, the purpose of said bill being the simplification and
codification of the laws of this State relating to the practice of medicine
and surgery.

Resolved, That the county and local medical societies of this State
and members of the profession generally are requested to promote, to

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T>^' 7*wr<#*ry rt-yrttA *:& fo\lowiz.z az-:'i:-arl;i.* for membership :

Jliv, Fmki/ S. Vi:t;ros. (jvjk W. Lew;-. Jk.. Geoege Clejstox

AwtUM, Ww, E. J/ >:•',, Joh.v deVelx#> Moj'Ee. -T. D. Hedtemaxx,

'\\n' wtmuttitw: i>\\ ^Clinical Te»t-? of Potencies" being about to
i^.iK' it dr^filar, the following re^ilution was adopted :

/AW/w/ f Tliattlirj ''//mmittee be instructed to refrain from inserting
jh Um' /'ir^uhir aboui to 1x5 ii>*ued 9 all expressions of opinions in refer-
ftu'H Ut l\tt: wcditttbility of eureri by *' high potencies/*

\Ui, \\s*\\iu>vi,K rwlhtfl attention to the impoverished finances of the
MoHHy iiim! utye*\ ;dl ftietribera to promptly remit their dues.

Mov*'<l by | In, Wom:ott, wjconded l>y Dr. Moffat, that the thanks
of llin HoriHy be teii(|iTc<| Ilu. Paine for his labors in behalf of
mi'illiMil h-j/i^ljilJon at Albany.

Thirty-Fifth Semi-Annual Meeting. 21

Dr. Paine suitably responded.

On motion of Dr. Moffat, seconded by Dr. Lenggenhager, a vote
of thanks was tendered the proprietors of the Cataract House for
their courteous attention and reduction of rates.

Dr. Nottingham cordially invited the Society to attend the meeting
of the Michigan State Homoeopathic Medical Society.

The Soeietv then adjourned.

PROCEEDINGS

OF THE

Thirty-Sixth Annual Meeting of the Homoeopathic Medical Society of the State

of New York, held in the Common Council Chamber, City Hall,

Albany, NY., Tuesday and Wednesday, February

8th and 9th, 1887.

The Society was called to order at 10 o'clock, a. m., by the President,
Henry C. Houghton, M. D., New York City.

Prayer was offered by Dr. J. J. Mitchell, of Newburgh.

The First Vice-President being in the chair, the President
delivered the following address :

Ladies and Gentlemen :

It seems but yesterday since your action placed me in this honorable
position and under renewed fraternal obligations. A few hours, the
year's work will have been completed and we shall launch upon the
unwritten history of another fiscal year. This is not the time for
moralizing, but one cannot fail to be impressed by the thought that
present opportunities must be seized upon without debate and earnestly
appropriated, lest tardy action cause unavailing regrets.

A review of the work of the Society for the year presents nothing
of unusual note. The interests of the Society are in the keeping of 1
the Executive Committee, ad interim, and any care they may have
had has been due to the activity and zeal of certain members, rather
than a solicitude that life should end from coma. The Legislative
Committee had an interesting " combine " early in the year, concerning
which we shall hear in detail from our irrepressible Chairman. The
session at Niagara Falls was a somewhat uproarious one, when we con-
sider the number present, and the fact that some of them were com-
pletely mystified and others subject to a proving of a potency of Dema ;
it is to be regretted that the members do not avail themselves of the
opportunities offered at the semi-annual sessions, for scientific discus-
sion and fraternal intercourse, free at that time from all the disturbing,
however necessary thev mav be, elements of legislative and official
transactions.

Thirty-Sixth Annual Meeting. 23

The intercourse of the year has been characterized by a fraternal
spirit, there being so iar as I know, no element of discord in our
midst. Our members are doing good service to mankind in the
activities of private practice and public charities ; giving an amount
of unrequited benefactions in the shape of skilled attentions and
expert advice, that is too often not only unrequited but apparently
unappreciated ; at other times, thank God, so heartily appreciated that
the compensation is beyond that of gold, because it shows that the
divine is not lost even among those counted of least esteem among men.

As a Society we have also the hearty support of the laity, as shown
by a private support as practitioners in the various communities of the
State, where we have the confidence of the best citizens, as they trust
to our care those whom they hold dearest in all the ties of life ; confi-
dence shown in the maintenance and multiplication of institutions for
the care of the sick, the support of the poor and the aged, as well as hearty
endorsement of our plans for the education of those who in coming
years must be ready to take upon themselves similar duty, as their
seniors drop from the ranks. We claim also the respect due to success,
from those who may not altogether agree with us as to our methods of
medication, and it is not an uncommon thing to have the counsel of
our experienced members solicited by those of opposite faith and
practice, in the medical care of their families. We claim, because we
merit, the respect of our friends of the opposite side, the dominant
school of medicine. We merit it because of success, because of sur-
vival ; having demonstrated, by a half century of testing, under the
most adverse circumstances, that we have a mission, even the redemp-
tion of the practice of the healing art from the crude, empirical,
unscientific, harsh, hazardous methods of the past, to the refined, fixed,
according to principle, gentle, safe methods of to-day. In this we
stand united, having parted with those who left us because they were
not of us. Possibly there a few malcontents in the camp ; absolute
unity is hardly to be expected in medical organizations. We are justly
labeled as more tenacious of our opinions than the clergy or the legal
practitioners, the natural result of ages of conservative practice.

If the respect which we claim from our friends, the enemy, had been
rendered to us fiftv years ago, there would have been no occasion for
u New Code ' ' enactments, no sects in medicine, no plea for " liberal
medicine.'" I have had occasion recently to refer to the history of our
Society in other relations and I find the lessons there learned not inop-
portune in this presence.

24 PkOTEKMNOS.

From lMf'j to l*. r iti all efforts to obtain any fraternal organization as
a representative body failed, because of the opposition of the •• regular
school" — so called. A glimpse of the nature of this opposition may
l>e had from the following sentence quoted from a letter to Hon. Win.
Kelly hy Dr. Vanderberg, written u[K>n the occasion of the passage uf
the Senate Hill, March 1, ls.">'i, authorizing the formation of honneop-
atiiic societies : •• What shall we render to yon for such service ?
You have abolished the sentence of outlawry, confirmed by the approval
of three generations against us! You have legalized a profession that
lias borne tlie finger of scorn for fifty years and have given ns the con-
solation of knowing that when the pilgrimage of this life is ended, we
may be buried in consecrated ground."

The younger members of this Society can have little idea of the ban
put upon those who adopted homoeopathic practice. It must be a sad
case that called for such words as the following from the lips of the
late Carrol Dunham, M. D. : " The most bitter aspersions upon Hahne-
mann's personal character, abounding in the most concentrated con-
tempt and scorn of the system which Hahnemann had unfolded — and
from that day to the present, all the utterances of the old school,
whether from the press, the council, the professor's chair, or in the
forum of the academy, have been bitter, personal denunciations of the
character and motives of Hahnemann, and of all who have adopted or
have even shown a disposition to investigate his methods."

Tn what manner and to what degree has the nature of the dominant
school changed i Will the lion and the lamb lie down together, with-
out demonstrating the falsity of the axiom, that two bodies cannot
occupy the same space at the same time { Personalty, there has come
a great change. Organically, officially, very little ; the societies adhere
to tlie same line of action that expelled our seniors. The younger men
are fraternal, progressive, glad to avail themselves of anything new, if it
be useful, helpful; but the genius of the medical profession is not
favorable to progressive ideas, and the young men must wait, not only
for fees, but also for freedom. The " New Code" episode in the his-
lopathic branch of the medical profession is the result
Din without rather than within the body. The spirit
one of liberality ; the laity have long had a supreme
ic bigoted policy that has hindered them from having
memlrere of our school, simply because the old school
; us. The fact is one that needs no argument ; the laity
■ practice, even in families nominally under old school
remedies in ordinary sickness, till they have been in

Thirty-Sixth Annual Meeting. 25

advance of the medical adviser, often abandoning the old for the new,
because of the conservatism which would not even listen to the pos-
sibility that good could come out of Nazareth." I have said that we
are to-day indebted to the intelligent, progressive laymen for the liberal
spirit that has controlled legislation, specially in this, the Empire State.

After fift3 T years of opposition in every way possible onr friends of
the dominant school have come to realize the fact that they cannot con-
trol legislation and carry a measure to success without recognizing our
claim to a respectful hearing, because we have and hold a large share
of the patronage of the wealthy and educated classes of community
and the public sentiment to support our practice. This is not a change
of nature, but a change in methods ; not altered purpose, but changed
plans, as one of our quasi friends said last year : " We have fought
homoeopathy for fifty years and it has prospered under persecution ;
now we propose to hug it to death." Well, this is in keeping with
history. By the aid of Ringer and Barthelow they have squeezed out
the principle in the shape of " Physiological Medicine" which is the
essence of Hahnemann's teaching; then they appropriated our phar-
maceutical processes by the " Fuller method" an instance of irregular,
regular, minimum dosage. Now they propose to expel the vital spark
by affectionate embraces.

Fable. — A certain professor of natural history gave his son a lesson
in bee culture, showing from plates the methods by which the bee
carried honey to the hive. One day when the little fellow was eating
sweets in the garden a bee lighted on his dish ; he thought he would
make some original investigation, so he caught the bee, but before the
search had advanced to the end desired, another end became active, and
the loving father was hastily sought for advice and comfort. Moral. —
Sinister methods are not safe. Ingenuousness is better than craftiness.

Allow me to dwell for a moment upon a term which I have already
quoted, " liberal medicine." It was my belief in " liberal medicine "
that made me a member of this Society ; it is that which will keep me
such till liberality is manifested by those at whose door lies the
responsibility for schools, and sects and divisions in the profession.
One of our oldest, ablest, most experienced, most successful physiciana
is senior editor of an able journal devoted to the interests of
liberal medicine, in the earnest effort to unite the profession. If I
mistake not, our honored colleague was never called to such a case of
dystocia ; the analogy will not bear severe strain, but if I suggest that
if the presentation be vertex or breech, the passage of liberty of thought
and action offered to us by the dominant school of medicine to-day is.

2*5 !*!:■■ *.k: »:>•--.

too narrow for tb> :-*dv. Well •::•] Dut.l.*::. -siv in h> address before

m m

this Soviet v in l^-*!. •• N«»w. a- :«. the d-v- .jf IL'.r.eiuaiin. there is an
antagonism l«etween the }.••:;. i-» •■•!•:.>:* .*:.d ::.e old school. The
former hold out to the letter wl.it tl.-v l«l : eve to lie that method
which ha> ever lieen a «!•— ; i»-ra*;*:. :•- :i.e»::cii.e. The latter refuse
even to examine it. ai.d ex;»-l ti •• :.■»::.• *-••;• •■•!.>!* fr«m all associations
over which ih»*v hoM contra. We caim*** nn:*e with theiu in anv
associated la'oors. without ijr;«»ri' z j'.'I disavow:::.; wh.it we 1 relieve to
lie the true theory and j»ra'-:l-^e of tl:e all i:i.>irt.i!:t jicirt of medical
fcience — the science of ti.err,»ent:«->. T^» " »rJ'l /•••* mw/7#- with us in
associate*! labors for the d»-v»-!-»p:iie::t of t:.> ^-iei.i-e.

I have a fellow fueling with th«»-e win* de-:rv ;hi- union. There are
few men who prefer to i»e ostracized, the fact of liking and courting
adverse criticism i- evidence of a **mred. uuhnmau. not to sav inhuman
di>jM>sition. Suffering for principle i< not choice — it is necessity.
Kelief from this po>itioii is not obtainable by art ion on our part, for
the only step possible on our part is retraction. The retraction must
come from the side that enacted the expu'-ion. Shall we win any
additional respect by making overture- to the dominant party ' Wooing
usually comes from the stronger. So when the venerable, the honor-
able, the wealthy, the manly old M-hool heart is smitten with a sense of
desirable union, we mav turn the right side and listen to the remarkable
change in its language. Meanwhile, we will maintain our position.

There is another reason for maintaining our |>o>itioii. We are under
obligation to transmit to others what we have received from our
seniors, a legacy of untold value, a power that has transformed medical
practice- I am not sure that the inertia of old medicine has been over-
come to such an extent that we can safely trust to momentum to carry
on the work. The time has not come when it is safe for a man to
announce in old school meetings results which he has obtained from
the exhibition of remedies known to be used bv us : he mav use them
in secret, but woe to him if he have the courage of his convictions and
announce the source of his knowledge. He is met by the cry, " These
are the method.-* of homoeopathy, let him who advocates them go where
they are practiced." When the law taught by Hahnemann, by which
our fathers triumphed, by which we hold our vantage ground, when
this law is admitted to be a law by which anyone may practice, with-
out ostracism ; when it is taught in our medical colleges, the choice of
practice being optional with the student ; when the public hospitals are
open to a fair test of practice ; when remedies prepared according to
our methods can be prescribed with hope of honest dealing; when

Thirty-Sixth Annual Meeting. 27

service in the army and navy is open to us ; when alumni of old school
colleges are retained upon their lists and they accept us as rightful pre-
ceptors ; in short, when all the doors closed against us are cordially
opened to us, then we may feel sure that the truth for the defence of
which our veteran members founded this Society, may be safely left to
do its beneficent work.

To the duties incumbent upon us let us address ourselves for another
year. To harvest the fruitage of the past, to sow for the future,
c ertain things must be kept steadily in view, seduously guarded.

First. This Society is strictly a fraternal one. It has a legal basis
it is true, but its success depends simply and solely on the community
idea, any personal party division element allowed to get foothold will
be a leaven of discord and destruction. For twenty years I have
attended these sessions with benefit to myself and to those over whom
I have had an influence ; the most attractive feature of the society life
has been the fraternity, the cordial fellow-feeling. I have not always
agreed with my colleagues, but I believe I have always respected their
right of judgment and the necessities of difference of belief and action
growing out of education, antecedents, any and all factors of human
life. I trust I shall never do otherwise. I am compelled to say that
during the past half year we have been threatened by a cloud, " no
bigger than a man's hand " it is true, but one that has in it the possi-
bilities of unhappy friction. I counsel calm, brief statement of
difiiculties, short discussion and a cheerful acceptance of the will of the
majority, joined with a respectful attention to the desires and hopes of
the minority.

Second. Finances. " Money makes the mare go." ' However much
stress may be placed on valuable papers, interesting discussions and
similar items, the success of this Society depends upon the management
of its finances and upon the treasurer. We have the plain fact before
us, of debt — a second fact, no prospect under present condition of
cancelling the debt, but of its increase. I have given some thought to
this matter and see but one course to pursue. The receipts are from
the dues of permanent members and the delegates from the County
societies — small amounts from sale of Transactions. These are insuffi-
cient to meet current expenses. The disbursements are for expenses of
the treasurer's office, salary of secretary, expenses of secretary's office,
and the issue of the Transactions. The expenses of the secretary and
of the treasurer, are much the same from year to year. The salary of
the secretary the same. Hence, the only way to free ourselves from
debt is to increase the receipts from permanent members and the sale

2fi pROCKKMNOS.

too narrow for this IkmIv. Well did Dunham sav in his address before

• *

this Society in 18f>3, " Now, as in the davs of Hahnemann, there is an
antagonism between the honxeopathists and the old school. The
former hold out to the letter what thev believe to be that method
which has ever been a desideratum in medicine. The latter refuse
even to examine it, and expel the homceopathists from all associations
over which thev hold control. We cannot unite with them in any
associated labors, without ignoring and disavowing what we believe to
be the true theory and practice of the all- important part of medical
science — the science of therapeutics. They will ?tot unite with us in
associated labors for the development of this science.

I have a fellow feeling with those who desire this union. There are
few men who prefer to be ostracized, the fact of liking and courting
adverse criticism is evidence of a soured, unlnmian, not to 6ay inhuman
disposition. Suffering for principle is not choice — it is necessity.
Relief from this position is not obtainable by action on our part, for
the only step possible on our part is retraction. The retraction must
come from the side that enacted the expulsion. Shall we win any
additional respect by making overtures to the dominant party ( Wooing
usually comes from the stronger. So when the venerable, the honor-
able, the wealthy, the manly old school heart is smitten with a sense of
desirable union, we may turn the right side and listen to the remarkable
change in its language. Meanwhile, we will maintain our position.

There is another reason for maintaining our position. We are under
obligation to transmit to others what we have received from our
seniors, a legacy of untold value, a power that has transformed medical
practice- I am not sure that the inertia of old medicine has been over-
come to such an extent that we can safely trust to momentum to carry
on the work. The time has not come when it is safe for a man to
announce in old school meetings results which he has obtained from
the exhibition of remedies known to be used by us ; he may use them
in secret, but woe to him if he have the courage of his convictions and
announce the source of his knowledge. He is met by the cry, "These
are the methods of homoeopathy, let him who advocates them go where
they are practiced." When the law taught by Hahnemann, by which
our fathers trium plied, by which we hold our vantage ground, when
this law is admitted to be a law by which anyone may practice, with-
out ostracism ; when it is taught in our medical colleges, the choice of
practice being optional with the student ; when the public hospitals are
open to a fair test of practice ; when remedies prepared according to
our methods can be prescribed with hope of honest dealing; when

Thirty-Sixth Annual Meeting. 27

First. This Society is strictly a fraternal one. It has a legal basis
it is true, but its success depends simply and solely on the community
idea, any personal party division element allowed to get foothold will
be a leaven of discord and destruction. For twenty years I have
attended these sessions with benefit to myself and to those over whom
I have had an influence ; the most attractive feature of the society life
has been the fraternity, the cordial fellow-feeling. I have not always
agreed with my colleagues, but I believe I have always respected their
right of judgment and the necessities of difference of belief and action
growing out of education, antecedents, any and all factors of human
life. I trust I shall never do otherwise. I am compelled to say that
during the past half year we have been threatened by a cloud, u no
bigger than a man's hand " it is true, but one that has in it the possi-
bilities of unhappy friction. I counsel calm, brief statement of
difficulties, short discussion and a cheerful acceptance of the will of the
majority, joined with a respectful attention to the desires and hopes of
the minority.

Second. Finances. "Money makes the mare go/' However much
stress may be placed on valuable papers, interesting discussions and
similar items, the success of this Society depends upon the management
of its finances and upon the treasurer. We have the plain fact before
us, of debt — a second fact, no prospect under present condition of
cancelling the debt, but of its increase. I have given some thought to
this matter and see but one course to pursue. The receipts are from
the dues of permanent members and the delegates from the County
societies — small amounts from sale of Transactions. These are insuffi-
cient to meet current expenses. The disbursements are for expenses of
the treasurer's office, salary of secretary, expenses of secretary's office,
and the issue of the Transactions. The expenses of the secretary and
of the treasurer, are much the same from year to year. The salary of
the secretary the same. Hence, the only way to free ourselves from
debt is to increase the receipts from permanent members and the sale

2fi pKocKunijifis.

too narrow fur this body. Well did Dunham say in liis address before
this Societv in 1S63, " Now, as in tlie days of Hahnemann, there is an
antagonism between the houneopathists and the old school. The
former hold ont to the letter what they believe to lie that method
which lias ever been a desideratum in medicine. The latter refuse
even to examine it, and expel the hoina'opathists front all associations
over which they hold control. We cannot unite with them in any
associated labors, without ignoring and disavowing what we believe to
he the true theory and practice of the all-important part of medical
science — the science of therapeutics. They will nut unit? with us in
associated labors for the development of this science.

I have a fellow feeling with those who desire this union. There are
few men who prefer to be ostracized, the fact of liking and courting
adverse criticism is evidence of a soured, unhnman, not to say inhuman
disposition. Suffering for principle is not choice— it is necessity.
Relief from this position is not obtainable uy action on our part, for
the only step possible on our part is retraction. The retraction must
come from the side that enacted the expulsion. Shall we win any
additional respect by making overtures to the dominant party '. Wooing
usually comes from the stronger. So when the venerable, the honor-
able, the wealthy, the manly old school heart is smitten witli a sense of
desirable union, we may turn the right side and listen to the remarkable
change in its language. Meanwhile, we will maintain our position.

There is another reason for maintaining our position. We are under
obligation to transmit to others what we have received from our
seniors, a legacy of untold value, a power that has transformed medical
practice. I am not sure that the inertia of old medicine has been over-
come to such an extent that we can safely trust to momentum to carry
on the work. The time has not come when it is safe for a man to
announce in old school meetings results which lie has obtained from
the exhibition of remedies known to be used by us ; he may use them
in secret, but woe to him if he have the courage of his convictions and
announce the source of his knowledge. He is met by the cry, "These
are the methods of homoeopathy, let him who advocates them go where
they are practiced." When the law taught by Hahnemann, by which
our fathers triumphed, by which we hold our vantage ground, when
this law is admitted to he a law by which anyone may practice, with-
out ostracism ; when it is taught in our medical colleges, the choice of
practice being optional with the student ; when the public hoapitalsare
open to a fair test of practice ; when remedies prepared according to
our methods can be prescribed with hope of honest dealing; when

Thirty-Sixth Annlal Meeting. 27

First. This Society is strictly a fraternal one. It has a legal basis
it is true, but its success depends simply and solely on the community
idea, any personal party division element allowed to get foothold will
be a leaven of discord and destruction. For twenty years I have
attended these sessions with benefit to myself and to those over whom
I have had an influence ; the most attractive feature of the society life
has been the fraternity, the cordial fellow-feeling. I have not always
agreed with my colleagues, but I believe I have always respected their
right of judgment and the necessities of difference of belief and action
growing out of education, antecedents, any and all factors of human
life. I trust I shall never do otherwise. I am compelled to say that
during the past half year we have been threatened by a cloud, " no
bigger than a man's hand" it is true, but one that has in it the possi-
bilities of unhappy friction. I counsel calm, brief statement of
difficulties, short discussion and a cheerful acceptance of the will of the
majority, joined with a respectful attention to the desires and hopes of
the minority.

Second. Finances. "Money makes the mare go." However much
stress may be placed on valuable papers, interesting discussions and
similar items, the success of this Society depends upon the management
of its finances and upon the treasurer. We have the plain fact before
us, of debt — a second fact, no prospect under present condition of
cancelling the debt, but of its increase. I have given some thought to
this matter and see but one course to pursue. The receipts are from
the dues of permanent members and the delegates from the County
societies — small amounts from sale of Transactions. These are insuffi-
cient to meet current expenses. The disbursements are for expenses of
the treasurer's office, salary of secretary, expenses of secretary's office,
and the issue of the Transactions. The expenses of the secretary and
of the treasurer, are much the same from year to year. The salary of
the secretary the same. Hence, the only way to free ourselves from
debt is to increase the receipts from permanent members and the sale

28 Prockkdinhs.

of the Transact !ous,i)Y for a time, at least, deprive the secretary of his
hard earned salary. An effort should he made to induce every member
' of our school who has been in practice ten years in the State, to become
a permanent member ; it would be a graceful return for the position
lie holds bv virtue of the labor of those who have maintained this
Society. It may be well to address an appeal to all such. The
receipts from delegates is fixed, hence no hope in that quarter.

The Transactions. I understand that the demand under present
conditions is limited, and we have not far to look for the reason.
Those who write papers for the Annual or Semi-Annual Meetings,
naturally desire that they should be published while fresh in mind ;
if allowed to publish them elsewhere, the Transactions are practically
valueless ; if we deny this, we dampen the interest of our sessions and
lessen the practical worth of our records. I propose that we
meet this dilemma by issuing our Transactions semi-annually in
two parts, one after each session, promptly, and hold all papers for
publication therein. Thus we shall make a demand for the Trans-
actions and meet the wishes of those who contribute. I am very
confident that this can be made practical. It is hard to find a good
Seeretarv for love or monev — some good woman usnallv finds him for
love, but the Societies seldom have monev for Secretaries. I find
that other State Societies do not pay a salary, but I should favor doing
so if once free from debt and able from sources mentioned to meet
that as an item of current expenses, for the burden of the routine
work falls upon him. Once free from debt, with increased revenue3
from the sources mentioned, I see no reason whv we could not
return to our present status.

Trusting that vou will do as medical men usuallv do in such mat-
ters, take this advice and these suggestions, and then do as your own
good judgment may dictate, we will take up the regular order of
business.

The President having resumed the chair, the Seeretarv read an
abstract of the minutes of the Semi-Annual Meeting, which was
approved.

The following Committees were then announced :

On Ptttiiknf* A<l<lrt*# — Drs. Mitchell, Uasbroiick and Gorham.
Ct\tf* nfiafe — Drs. Terrv and Latimer.
Auditing — Drs. Bull and Waldo.
Inrihition* — Drs, Watson and Brown.

Thirty-Sixth Annual Meeting. 29

On Regent*? Degree — Drs. Moffat and Bryan.

Chairmen of Bureaux and Censors — Drs. Lewis, Watson and

Strong.

Permanent and Honorary Members — Drs. Holden, Bryan and
Brown.

REPORT OF THE BOARD OF CENSORS.

On recommendation of the Board of Censors the following were
duly elected Permanent Members :

Names of Applicants,

Drs. G. T. Borden, Caledonia, Livingston County ; Fred S. Fulton,
New York City ; J. D. Heineman, Buffalo, Erie County ; George
Clinton Jeffery, Brooklyn. Kings County ; George W. Lewis, Jr.,
Buffalo, Erie County ; Wm. E. Long, Buffalo, Erie County ; J. de Velio
Moore, Utica, Oneida County ; Scott W. Skinner, Le Roy, Genesee
County ; Joseph II. Chamberlain, Belfast, Allegheny County ; Mark S.
Purdy, Corning, Steuben County ; Ferdinand Seeger, New York City ;
Charles E. Walker, West Henrietta, Monroe County ; M. W. Van
Denburg, Fort Edward, Washington County ; II. D. Schenck, Brook-
lyn, Kings County ; D. B. Hunt, New York City; De Witt G. Wilcox,
Buffalo, Erie County ; P. A. Banker, Rhinebeck, Dutchess County,
N.Y. .

The following members, delegates and visitors were in attendance
during the sessions :

Drs. Nelson Hunting, J. W. Cox, E. Darwin Jones, Jas*. F.
McKown, H. M. Paine, L. M. Pratt, Wm. W. Seeley, C. D. Welch,
W. F. Robinson, R. B. Sullivan, II. L. Waldo, G. H. Billings,
Albany Co.; T. L. Brown, Broome Co.; C. P. Cook, S. E. Calkins,
Columbia Co.; David E. Collins, Greene Co.; L. A. Bull, F. Park
Lewis, Erie Co.; D. A. Gorton, W. C. Latimer, E. Hasbrouck, J. L.
Moffat, Kings Co. ; C. E. Walker, Herbert M. Dayfoot, J. M. Lee,
Monroe Co.; Louis Faust, Montgomery Co.; T. M. Strong, D. B.
Hunt, Sidney F. Wilcox, Geo. M. Dillow, Fred. S. Fulton, Henry C.
Houghton, New York Co.; Wm. H. Watson, M. O. Terry, Oneida Co.;
John J. Mitchell, Selden H. Talcott, Orange Co.; Frank L. Vincent,
E. S. Coburn, Hiram E. Fuller, Rensselaer Co.; D. E. Spoor, Schen-
ectady Co.; A. J. Frantz, Seneca Co.; E. W. Bryan, Mark S.
Purdy, Steuben Co.; A. W. Holden, Washington Co.; H. P. Part-
ridge, Bennington, Vt.

30 Proceedings.

REPORT OF THE TREASURER.

The Treasurer, Dr. E. S. Ooburn, presented the following report :

Troy, N.. Y., Feb. 8th, 1887.

Edward S. Coburti, M. D., Treasurer, to The Homoeopathic Medical
Society of the State of New York, Dr.

To cash from permanent members, $644 20

" u county societies, 198 00

" " sale of books, 106 50

collected for general index, '. 48 00

special collection at Niagara Falls, 22 00

donation by Dr. J. F. Cooper, 5 00

$1,023 70

CONTRA. CR.

By cash paid as per vouchers, $1,023 70

ASSETS.

Twenty-two certificates of membership not paid for, $ 44 00

Four members, five years in arrears, 60 00

Sixteen members, four years in arrears, 192 00

Seventeen members, three years in arrears, 153 00

Twenty-one members, two years in arrears, 126 00

Nineteen members, one year in arrears, 57 00

$632 00

LIABILITIES.

Balance of Secretary's salary, , . . . . $319 31

Referred to the Auditing- Committee, who subsequently reported
the following :

Feb. 8th, 1887.

To President and Members of New York State Homoeopathic
Medical Society :

The undersigned Committee of Audit of Treasurer's Accounts do
hereby report that we have examined the books and vouchers of said
Treasurer, and find the same correct. L. A. Bull,

II. L. Waldo.

On motion Dr. Hiram E. Fuller, of Lansingburgh, N. Y., and
Dr. H. P. Partridge, of Bennington, Vt., were invited to participate
in the proceedings of the Society.

Thirty-Sixth Annual Meeting. 31

REPORT OF THE COMMITTEE 02* LEGISLATION.
The report was presented by the Chairman, H. M. Paine, M. D.

The Committee on Legislation respectfully report that they have
endeavored to comply with the resolutions adopted by the Society last
year, the essential provisions of which were the preservation of the
law of 1872, providing for the appointment of State examining
boards ; also, so far as might be practicable, to unite with the old
school in efforts to secure the passage of a bill for better regulating
medical practice.

The usual attempt, was made last winter in the early part of the ses-
sion of the legislature, to promote the passage of a Bill providing for
both the appointment of a single board of State medical examiners
and for regulating medical practice.

This Bill, in the Assembly, was referred to the judiciary committee.
This committee gave both its friends and opponents an extended hear-
ing, and, after listening to the arguments presented by the committee
of this Society and others, against the formation of a single State
board of medical examiners, on the ground that thereby there would
be created a powerful medical monopoly, composed of representatives
of one school of medicine, promptly reported the Bill adversely,
thereby arresting further progress for that session.

Your committee then united with the committee of the old school
in efforts to obtain the passage of a bill for codifying the laws of the
State regarding the regulation of medical practice. This Bill, known
as Senate Bill 485, passed the Senate, but owing to unexpected oppo-
sition at the last hours of the session, failed in the Assembly.

In order that the homeopathic profession throughout the State might
become fully acquainted with purposes had in view, and the plans for
protecting and perpetuating homoeopathic interests, the committee
issued a pamphlet of sixteen pages, in which is clearly set forth the
position held by the homoeopathic school, more particularly an extended
argument against the appointment of single State boards of medical
examiners.

Copies of this pamphlet have been mailed to secretaries of county
medical societies as far as their addresses could be obtained.

The present purpose of the old school seems to be, to relinquish, for
the present, its efforts to secure a single State board of medical exam-
iners, and to promote such legislation regarding the regulation of
medical practice as both schools can agree upon, the matter of simplify-
ing and rendering more effective existing medical laws being consid-
ered paramount to all other questions.

32 Proceedings.

In order to give practical effect to this purpose, a Bill, prepared by
W. A. Purrington, Esq., of New York, has been again presented to
the Legislature, and has already been reported favorably by the Senate.

This Bill is substantially the same as that known as Senate Bill 485,
of last year. A few paragraphs have been changed, and some of its
harsher features modified. Its good qualities, in defining and estab-
lishing a suitable standard of educational requirements, and in its clear
and decisive bearings upon irregular practice, cannot be too highly
commended.

This Bill, now known as Senate Bill 45, ought at once to receive the
unqualified approval of the whole medical profession.

A copy of the circulars issued by the committee are herewith sub-
joined, under Appendix A, B and C.

The expenses incurred in the publication and issuing of these vari-
ous statements, has been in part met by members of the committee,
and are as follows :

For printing slips, copies of proposed medical bills, blank and
circulars, $45.75.

For extra copies of newspapers containing reports or references
thereto, and postage, $12.48. "

Toward which twenty-five dollars has been paid by members of the
committee, leaving an unpaid balance of $33.23.

The committee would recommend that effort be continually made
for preserving the provisions of the Law of 1872 by which the several
schools of medicine are now provided with examining boards of their
own ; and also that the support of the homoeopathic school be given
to the present Bill for regulating medical practice.

With these purposes in view, we offer the following resolutions :

Itesolved, That in the opinion of this Society it is desirable that the
provisions of the Law of 1872, whereby the different schools of med-
icine- in this State are provided with separate examining boards,
should be preserved and perpetuated.

Resolved, That whenever the provisions of this law are changed,
they should be so amended as to confer upon the boards appointed
thereunder, both examining and licensing powers.

Itesolved, That we approve the enactment of the present Bill, known
as Senate Bill 45, the purposes of which are the codification of the
present laws relating to medical practice and the better regulation thereof.

Resolved, That the committee on medical legislation be instructed
to endeavor to carry out and render effective the purposes and recom-
mendations herein set forth.

All of which is respectfully submitted,

H. M. Paine, E. S. Coburx,

E. Hasbrouck, John J. Mitchell.

Geo. E. Gorham, Herbert M. Dayfoot.

Thirty-Sixth Annual Meeting. 33

APPENDIX A.

Statement Issued by the Committee on Medical Legislation of the Homoeopathic
Medical Society of the State of New York, November, 1886.

To the Homoeopathic Medical Profession :

The Committee on Medical Legislation desire to call the attention of
the homoeopathic profession of this State to the following statement :

An effort was again made last winter, for the fourth or fifth time, to
secure the passage of a bill providing for a single, old school State
board of medical examiners, composed of nine members, including, for
the sake of representation, one homoeopathic and one eclectic physician.

REASONS FOR OPPOSING A SINGLE EXAMINING BOARD.

The committee strenuously opposed this Bill, for the following
reasons :

That the creation of such a board would practically establish a per-
manent and powerful medical monopoly of the licensing franchise,
under the immediate control of one school of medicine, thereby con-
stituting an exceedingly objectionable form of class legislation.

That the consciousness of the possession of the power thereby vested
in the representatives of the dominant school would, whether intended
or not, operate as a constant menace upon the less numerous schools ;
would tend to strengthen the majority, and would prove constantly
detrimental to the growth and permanence of the schools represented
by the minority.

That the unequal representation therein provided for would be con-
sidered a mark of degradation and subserviency, which would stamp
the homoeopathic minority with a perpetual brand of inferiority.

That the functions of the examining board being administrative,
the basis of representation therein, of the different schools, must, of
necessity, be equal, like that of the United States Senate, in order that
the judicial powers of each school may be no greater than those of the
other two. Unequal representation of the different schools in a
single examining board, would place a premium upon favoritism.

That no adequate provision is made for checking favoritism on the
part of the majority which, sooner or later, would inevitably occur ;
hence an act of great injustice would be done to the homoeopathic
school by the establishment of a single board, on the basis proposed by
this bill, the plan of secret examinations therein provided being open
to many practical objections.

34 Proceedings.

Tliat the homceopathic students, regardless of their wishes or pref-
erences, would be placed completely in the power of what would be
practically an old school examining l>oard.

That, as homoeopathists, we insist that the qualifications of homoeo-
pathic students shall be determined by a homoeopathic examining
board.

That, on account of the antagonism, rivalry and jealousy existing
between the different branches of the medical profession, one school
ought not, by any means, to be clothed with arbitrary and irresponsi-
ble power, such as this bill provides.

That it will be impolitic and against public welfare to force by law
a coalition involving important rival interests, until there are evidences
of greater harmony between the two principal schools; and particu-
larly not until the old school acknowledges the applicability of homoeo-
pathic principles by adopting them in practice and teaching them in
their own medical schools.

That, in order to establish a sufficientlv uniform standard of attain-
ments, a single State examining board is no more a necessity in medi-
cine than in law or theology, in both of which an entrance into these
professions is gained through several sources, there being no valid
objections thereto on the ground of defective thoroughness.

That the present law, that of 1872, authorizing the appointment of
State boards of medical examiners, by which each school is provided
with its own examining boards, thereby enabling it to accomplish its
own educational work untrammeled by the presence of hostile mem-
bers, is fully in accord with the principles of equal representation ;
and, by its abundant safeguards, is sufficiently effective to meet the
exigencies of public and professional requirements.

That having originated and perfected this law, and having for four-
teen years maintained thereunder, dissociated from unfriendly interfer-
ence, a recognized official status ; and having complied with its
nnsectarian and catholic provisions, satisfactorily to ourselves, and with
careful regard for professional and public interests ; we see no good
reason, under existing relations, for forming an alliance by which our
school will be in a great measure deprived of the privilege of perform-
ing its full share of educational work ; on the contrary, our experience
establishes the conviction that professional interests and the public
welfare will be more effectually protected and promoted by perpetu-
ating its wise, liberal and conservative principles.

That having secured the appointment of the first State examining
board, and having enjoyed its advantages undisturbed these many

...j

Thirty-Sixth Annual Meeting. 35

years, we are warranted in urging our old school colleagues to lay aside
their prejudices against this admirably -arranged, equitable and effective
law, and give it a fair and impartial trial for an equal length of time,
before putting forth efforts to supplant it by a method, the operations
of which would unquestionably prove destructive to their less numer-
ous rivals.

That in our opinion the only defect in this law is found in the fact
that its benign and salutary provisions are voluntary one6 ; that in order
to insure thorough effectiveness, its enforcement must be made com-
pulsory, after a certain prescribed date, upon all who wish to enter
upon practice in this State*

That with this purpose in view, we will join our colleagues of the
old 3chool in procuring such amendments thereof as will make the
provisions of this law equally binding upon the representatives of the
three legally recognized systems of practice ; provided such amend-
ments shall not interfere with the appointment of separate examining
boards for each school ; furthermore, we are free to state that, in our
opinion, after long investigation of this subject, and ample practical
experience, this change of law of 1872 constitutes the only needed
reform in the matter of establishing suitable tests of medical scholar-
ship.

That, in conclusion, we actively oppose the formation of a single
State examining board, on account of the fact that this effort con-
stitutes a part of a widely extended, well arranged "and systematic
plan, indorsed by the American Medical Association, for practically
placing the management of medical affairs, as far as is possible,
throughout the whole country, under the direct control of one school
of medical men ; that this pernicious system having been already
established in several States, notably those of Alabama and Virginia, is
now producing effects the most disastrous upon Homoeopathy, wholly-
arresting its progress by prohibiting accessions thereto ; a most un-
American system ; one which must be met by the most determined
opposition on the part of all who desire to promote entire liberty of
opinion and freedom of action among educated medical men.

Homoeopathists do not wish to place themselves in antagonism
to medical legislation having for its object the promotion of public
interests ; hence do not in this instance oppose the old school bill
without, at the same time, providing, in their opinion, a better method,
the substitute which they offer being the present law, that of 1872.

The application of this law has fully demonstrated the wisdom of
its f ramers. It furnishes abundant means by which the several schools

36 Proceedings.

are provided with examining 1x>ards of their own selection, placed
wholly under their own control. Its equitable and conservative pro-
visions may he summarized as follows :

It is equal in application: the representatives of each of the three
schools being placed upon the same footing, no preference being shown
to one more than another.

Its operations are open to public inspection ; hence it is a thoroughly
effective law. It provides abundant checks and safe-guards against
intentional fraud on the part of the members of any board, by holding
their action subject to the approval of the regents, and by placing all
the evidences of the qualifications of each applicant on record for
public inspection.

It is a safe law, in that it cannot l>e made instrumental in awakening
sectional jealousies, because it is purely democratic in its methods of
application and administration.

It establishes a uniform standard of acquirements outside the ranks
of the profession ; hence it is an impartial law. It leaves each school
free to exercise its own prerogatives untrammeled by the presence or
interference of either of the others ; at the same time each board is
held responsible for its own acts to an impartial, non-sectarian and non-
professional court, the board of regents, who are competent to deter-
mine and enforce compliance with a uniform and sufficiently rigid
standard of acquirements.

For these reasons homoeopathists are disinclined to give up a system
which has stood the test of experience without friction, and one
embracing within its provisions such correct forces as will forever
render its execution practically effective and equally useful to the whole
profession and the public.

On the presentation of the argument, of which the foregoing is a
summary, the committee of the Senate and Assembly promptly reported
adversely the bill to create a single State examining board.

REASONS FOR SUPPORTING A BILL TO REGULATE MEDICAL PRACTICE.

This particular form of medical legislation, upon which the repre-
sentatives of the two principal schools could not agree, having been by
the foregoing action of the Legislature, effectually disposed of, at least
for one year, associated effort on the part of representatives of all
schools was concentrated upon the construction of a bill for the more
thorough regulation of the practice of medicine and surgery in this
State, this question being one on which all educated members of the
medical profession are in accord.

Thirty-Sixth Annual Meeting. 37'

The form which resulted from this effort was known as Senate Bill
485 and Assembly Bill 903, session of 1886. This Bill was approved
by the Senate, but was, during the closing hours, lost in the Assembly.

This Bill embraces within its several sections all the essential pro-
visions of all former enactments, and in its last section repeals all laws
or parts thereof which have any reference whatever to medical and
surgical practice, specifying each by name, number and date, thereby
forming a practical codification of all the laws of this State regulating
the practice of medicine and surgery.

Moreover, this Bill is so constructed as that, in case further legislation
is entered upon with a view of changing the method of medical licens-
ure, by its withdrawal from the medical colleges and placing it in
charge of State boards of medical examiners, the second section only
will require amendment ; all the other sections of the Bill may remain
without alteration.

The old school physicians who are endeavoring to change the present
law, that of 1872, so as to provide for a single State examining board,
are unquestionably actuated by a worthy motive, that of improving,
unifying and elevating the standard of medical acquirements. As far
as regards the object had in view, both schools are in accord ; homoeop-
athists, however, object to a method which will surely tend to the dis-
integration of their own school. They prefer a board of their own,
and believe the people of this State will sustain them in their efforts
to preserve and perpetuate the essential provisions of the present law.

These statements are made at length, in order to promote intelli-
gent, harmonious and effective effort on the part, and to secure the
active cooperation, of the homoeopathic profession.

The committee hope that all the county and local medical societies
in this State will adopt resolutions approving the preservation of the
provisions of the law of 1872 ; and also approving the passage of a bill
for regulating medical practice, having the essential provisions of
Senate Bill 485, session of 188ti, a copy of which will be mailed to the
secretary of each county homoeopathic medical society.

Copies of these resolutions, when adopted, and of newspapers con-
taining them, should be forwarded promptly to the chairman of the
committee, Dr. H. M. Paine, of Albany. Such evidences of approval,
coming from all parts of the State, will greatly aid the committee,
during the coining winter, in case effort should be made to repeal the
law of 1872.

The following resolutions were unanimously adopted at the semi-
annual meeting of the State Society, held September 7, 1880:

Proceedings.

rhat the Homoeopathic Medical Societv of tlie State of
ndorses tlie proposition made by the Medical Society of
New York, as set forth by its Committee on Legislation
i to tlie recent session of the State Legislature under
35 ; the purpose of said Bill being the simplification and
f the laws of th'.s State relating to the practice of inedi
ery.
That the county and local medical societies of this State

of the profession generally are requested to promote, to
tent, tlie early enactment of a law providing for an in-
<ucy of laws regulating medical practice, as embodied by
io of the session of 1&S6.

That this Society indorses the action of its Committee on
11 opposing tlie passage of the bills presented to the last
f this State, providing for tlie appointment of a single

of medical examiners, the membership of which was
irofessors of medical colleges and an unequal representa-
fferent schools of medical practice.

That this Society heartily reiterates its endorsement of
is of the present law, that of 1872, by which the repre-
the three legally recognized schools of medicine are now
ed to appoint one or more examining boards under their
; a law, the limitations of which provide all necessary
ld at the same time prevent liability to favoritism and
von isms sure to occur in the case of a single mixed ex-
hat this Societ}' again, in the most positive terms, instructs
s on Legislation to endeavor to prevent the repeal of the
roviding for the appointment of State boards of medical
it of 1872; also, if feasible, to endeavor to Becure an
lereof, providing for a withdrawal from the medical col-
State of the right of medical licensure.

ilS OF THE BILL TO REGULATE MEDICAL PRACTICE.

ed Bill to regulate the practice of medicine and surgery
the following synopsis ; the first and second sections are

igulato the Licensing and Registration of Physicians and
:id to Codify tlie Medical Laws of the State of New York.
I 485, and Assembly Bill 903. session of 1SS6.)
I. No person shall practice physic or surgery in this State
have attained the age of twenty-one years ; and no person
as aforesaid unless he or she shall be, at the time this Act
:ct, a person lawfully engaged in such practice in this
;ense or authority conferred by its laws then in force, or
le shall be licensed or authorized so to practice by the
:his Act.

Thirty-Sixth Annual Meeting. 39

Sec. 2. From and af cer the date of the taking effect of this Act, no
. person shall be deemed licensed or authorized to practice physic or
surgery in this State, except one of the three following classes :

First. All who shall have been graduated from an incorporated
medical school or college in this State with the degree of doctor of
medicine, after substantial compliance with all the requirements of the
general laws and of the charter of said corporation regulating the term
and amount of study, attendance and attainment requisite to obtain said
degree ; provided that no person shall receive the degree of doctor of
medicine, or be licensed to practice physic or surgery in this State,
unless he shall have pursued the study of medical science for at least
three years after the age of eighteen, with some physician and surgeon
duly authorized by law to practice physic or surgery ; and shall also,
after the 6ame age, have attended two complete courses of lectures in
some legally incorporated medical school or college, in good standing
at the time of such attendance, prior to the granting to him or her of a
diploma or license ; provided, further, that two courses of lectures,
both of which shall be either begun or completed within the same
calendar year, shall not satisfy the above requirement.

Second. All who have received said degree after substantial com-
pliance with the requisites preliminary to its attainment, from a legally
constituted board of medical examiners of this State.

Third. All who, having been graduated from incorporated medical
schools or colleges without the State as doctors of medicine, or licensed
to practice physic or surgery under the laws of those European
countries in which said degree does not confer the right so to practice,
shall procure their diplomas from said corporations, or their licenses
from such countries, to be indorsed by the faculty of an incorporated
medical school or college within this State, or by a legally constituted
board of medical examiners of this State. Every such indorsement
shall be in form of Schedule A or of Schedule B of this Act. Every
corporation or board so indorsing, shall keep a record of their indorse-
ments, and may require applicants to verify their statements under
oath ; any indorsement made with fraudulent intent, or gross careless-
ness or ignorance, shall be deemed a misdemeanor, and shall subject
the indorser or indorsers, upon conviction thereof, to a fine of two
hundred and fifty dollars.

Sec. 3. Provides for registration.

Sec. 4. Provides for reregistration, on removal from one county to
another.

Sec. 5. Exempts all who are at the present time lawfully registered,
from the provisions of the bill ; also provides that after October 1st

40 . "Proceedings.

no registration shall be considered valid except the license described
in the second section.

Sec. 6. Defines the meaning of the term " practice of physic or
surgery"; states what constitutes irregular practice; and declares
an infringement of the law to be a misdemeanor.

Sec. 1. Excludes from practice all who have been convicted of a
felony ; declares all who have swom falsely to any affidavit, or who
have obtained a diploma fraudulently, to be guilty of a misdemeanor ;
fixes the penalty therefor, and places the burden of proof of innocence
upon the defendant.

Sec. 8. Declares that an unlicensed practitioner shall not be able to
collect fees by law ; permits an aggrieved party to recover twice the
value of fees he may have previously paid for such irregular service ;
and gives county medical societies the right to collect twenty-five
dollars from unlicensed and unregistered practitioners for the first, and
fifty dollars for subsequent offences, the excess over costs to be paid to
the State Board of Charities.

Sec. 9. Defines the exceptions from the provisions of the Act to be :
commissioned medical officers of the army and navy, members of a
medical or surgical staff of a hospital, dentists and physicians from
neighboring States in consultation.

Sec. 10. Repeals all laws and parts thereof, specifying each by
name, number and date, enacted since eighteen hundred and six to
the present time, which relate to the practice of physic or surgery in
tliij State, except chapter seven hundred and forty-six, laws of eighteen
hundred and seventy-two (and chapter six hundred and seventy-nine,
laws of eighteen hundred and eighty-one, amendatory thereof), being
the present law authorizing the appointment of separate State boards
of medical examiners for the different schools of medicine.

PROPOSED MEDICAL LEGISLATION.

In all probability a Bill, modified somewhat in minor points, yet sub-
stantially the same as the foregoing, will be introduced, and its passage
advocated by the old school. Its essential provisions, being in the main
founded on correct principles few members of tlte profession of either
school will interpose any objections thereto: on the contrary, will, as
far as may he in their power, endeavor to promote its passage.

It is also presumable that Bills will be again introduced, at the
approaching session of the Legislature, providing fur the appointment
of a single State Board of Medical Examiners. This will be done for
the purpose of separating the teaching from the licensing interests, in

Thirty-Sixth Annual Meeting. 41

order that the standard of medical attainments, as in law and theology,
may be determined and established by bodies other than those who are
interested in imparting instruction.

If this is attempted, instead of favoring a Bill to create a single
State examining board, the committee urgently request homceopathists
to support a Bill amending the present law, that of 1872, thereby
preserving and perpetuating the appointment of separate boards for
each school of medicine. A copy of this form is herewith subjoined.

On the other hand, if no further attempts are made to change the
present law so as to establish a single examining board, and all effort
at medical legislation, during the coming winter, is concentrated upon
the Bill to regulate medical practice, the committee urge homceop-
athists to give the Bill their united and cordial support.

After the passage of the Bill regulating medical practice — a synopsis
of which has been previously given — in case effort is then made to
change the present system of granting licenses, two amendments
will be required, in order to protect homoeopathic interests. These
are : one to slightly modify two sections of the law of 1872 ; the
other to change the second section of the law regulating medical
practice, so as to provide each school with boards of its own.

These amendments will be presented substantially in the following
forms, which are here introduced in order that homoeopathists may be
able to give them their active support when the time for such aid
shall have arrived :

LEGISLATION TO PROTECT HOMCEOPATHIC INTERESTS.

Proposed amendments of two sections of the law of 1872.

Sec. 5, Any person over twenty -one years of age, of good moral
character, and paying not less than fifteen dollars into the treasury
of the University, on applying to the Chancellor for the aforesaid
examination shall receive an order to that effect, addressed to one
of the boards of examiners, provided said applicant shall adduce
proof satisfactory to the Chancellor of having received the degree of
doctor of medicine from some legally incorporated medical college.

Sec. 6. The Regents of the University, on receiving the afore-
said reports of the Examiners, and on finding that not less than five
members of a Board haye voted in favor of a candidate, shall issue
to said applicant a license to practice physic or surgery in this State,
which license shall confer all the jjrivileges and immunities and im-
pose all the obligations and penalties now established \ or that may
hereafter be established by the laws of this State relating to the
practice of physic or surgery therein.

42 Proceedings.

Proposed amendment of the second section of the law regulating
medical practice, the purpose of this amendment being to preserve
and perpetuate the provisions of the law of 1S72, whereby each
school may lie provided with its own boards of medical examiners.

Sec. 2. From and after the first day of eighteen hundred

and eighty , no person shall be deemed licensed or authorized

to practice physic or surgery in this State except those who shall have
been graduated from an ineorpo rated medical school or college in this
State, with the degree of doctor of medicine, after substantial compli-
ance with all the requirements of the general laws, and of the charter
of said corporation regulating the term and amount of study, attend-
ance and attainment requisite to obtain said degree ; provided that no
person shall receive the degra3 of doctor of medicine, or be licensed to
practice physic or surgery in this State, unless he shall have pursued
the studv of medical science for at least three vears after the age of
eighteen, with some physician and surgeon duly authorized by law to
practice physic or surgery ; and shall also, after the same age, have
attended two complete courses of lectures in some legally incorporated
medical school or college in good standing at the time of such attend-
ance, prior to the granting to said person a diploma or license ; pro- v
vided further, that two courses of lectures, both of which shall be
either begun or completed within the same calendar year, shall not sat-
isfy the above require aient ; and it is fur 'her provided that, in addi-
tion to the foregoing, said person, after having received said degree,
and also those who have received a license to practice physic or sur-
gery under the laws of European countries in which said degree does not
confer the right to so practice, shall not he permitted to practice physic
or surgery in this State, until said person shall have been examined
and recommended by a State board of medical examiners, appointed
under chapter seven hundred and forty-six, of the laws of eighteen
hundred and seventy-tioo / and it is further provided* that the regents
of the university are hereby prohibited from granting or issuing, on
tlie recommendation of said boards of examiners^ any degree, title or
privilege other than a license to practice physic or surgery in this
State.

The proposed additions and changes are printed in italics. Just
what these are can be easily determined by a comparison with the sec-
ond section of the Bill to regulate medical practice previously furnished
in this circular.

In conclusion, the committee hope that homceopathists throughout *
the State will, during the coming fall and winter, endeavor to call on

Thirty-Sixth Annual Meeting. • 43

members of the Legislature from their localities respectively, and urge

them to support the Bill to regulate medical practice, and to oppose

any Bill or amendment designed to change the present law, that of

1872, except as suggested in the foregoing forms, which are designed

to render its provisions obligatory upon the representatives of all

schools alike.

H. M. Paine,

George E. Gorham, Jno. J. Mitchell,

Lester M. Pratt, Herbert M. Dayfoot,

Selden H. Talcott, A. K. Wright,

Everitt Hasbrouck, E. M. Kellogg,

Asa S. Couch, Edward S. Coburn,

Committee,

APPENDIX B.

To the Homoeopathic Medical Profession ;

The purposes had in view in issuing the accompanying pamphlet
are as follows :

First To furnish information and to set forth the reasons for pre-
serving the provisions of the law of 1872, by which the several schools
are provided with their own boards of medical examiners.

Second. In case effort should again be made to secure the passage
of a Bill providing for a single State examining board, to exert every
reasonable effort to prevent such legislation ; and instead, to promote
the passage of an amendment of the present law of 1872, thereby mak-
ing its liberal provisions compulsory upon all schools alike.

Third. Whether the foregoing is attempted or not, the profession
is invited to promote the passage of a Bill, similar to that of last winter
(Senate Bill 485, session of 1 886), for the better regulation of medical
practice, provided its construction is such as not in any manner to in-
terfere with or rescind the provisions of the law of 1872.

The homoeopathic medical profession are requested to preserve the
accompanying pamphlet for future reference, and, by personal appeal
and correspondence, request their members of the Legislature respect-
ively, prior to, and during the approaching session, to carry out its
benign and equitable provisions.

They are also requested to send for copies of the pamphlet, when
desired for distribution to members of the Legislature or others who
may have influence in furthering the purposes intended to be secured.

42 Proceedings.

Proposed amendment of the second section of the law regulating
medical practice, the purpose of this amendment being to preserve
and perpetuate the provisions of the law of 1872, whereby each
school may be provided with its own boards of medical examiners.

Sec. 2. From and after the first day of eighteen hundred

arid eighty , no person shall be deemed licensed or authorized

to practice physic or surgery in this State except those who shall have
been graduated from an incorporated medical school or college in this
State, with the degree of doctor of medicine, after substantial compli-
ance with all the requirements of the general laws, and of the charter
of said corporation regulating the term and amount of study, attend-
ance and attainment requisite to obtain said degree ; provided that no
person shall receive the degree of doctor of medicine, or be licensed to
practice physic or surgery in this State, unless he shall have pursued
the study of medical science for at least three years after the age of
eighteen, with some physician and surgeon duly authorized by law to
practice physic or surgery ; and shall also, after the same age, have
attended two complete courses of lectures in some legally incorporated
medical school or college in good standing at the time of such attend-
ance, prior to the granting to said person a diploma or license ; pro-
vided further, that two courses of lectures, both of which shall be
either begun or completed within the same calendar year, shall not sat-
isfy the above requirement ; and it is fur 'her provided that, in addi-
tion to the foregoing, said person, after having received said degree,
and also those who have received a license to practice physic or sur-
gery under the laws of European countries in which said degree does not
confer the right to so practice, shall not be permitted to practice physic
or surgery in this State, until said person shall have been examined
and recommended by a State board of medical examiners, appointed
under chapter seven hundred and forty-six, of the laws of eighteen
hundred and seventy-two / and it is further provided* that the regents
of the university are hereby prohibited from granting or issuing, on
the recommendation of said boards of examiners, any degree, tith or
privilege other than a license to practice physic or surgery in this
State,

In conclusion, the committee hope that homoeopathists throughout
the State will, during the coming fall and winter, endeavor to call on

Thirty-Sixth Annual Meeting. ■ 43

members of the Legislature from their localities respectively, and urge

them to support the Bill to regulate medical practice, and to oppose

any Bill or amendment designed to change the present law, that of

1872, except as suggested in the foregoing forms, which are designed

to render its provisions obligatory upon the representatives of all

schools alike.

H. M. Paine,

George E. Gorham, Jno. J. Mitchell,

Lester M. Pratt, Herbert M. Dayfoot,

Seldek H. Talcott, A. R. Wright,

Everitt Hasbrouck, E. M. Kellogg,

Asa S. Couch, Edward S. Coburn,

Committee.

APPENDIX B.

To the Homoeopathic Medical Profession :

The purposes had in view in issuing the accompanying pamphlet
are as follows :

First. To furnish information and to set forth the reasons for pre-
serving the provisions of the law of 1872, by which the several schools
are provided with their own boards of medical examiners.

Third. Whether the foregoing is attempted or not, the profession
is invited to promote the passage of a Bill, similar to that of last winter
(Senate Bill 485, session of 1886), for the better regulation of medical
practice, provided its construction is such as not in any manner to in-
terfere with or rescind the provisions of the law of 1872.

44 Proceedings.

It is hoped that all the county and local medical societies' in the

State will, as soon as possible, adopt resolutions approving the objects

herein set forth, and will mail a copy thereof to the chairman or any

member of the committee.

Yery respectfully,

H. M. Paine,

Chairman of the Com. on Legislation.

APPENDIX C.

The following resolutions were unanimously adopted at a meeting
of the Homoeopathic Medical Society, held

Resolved, That in the opinion of this Society, public and profes-
sional interests will be more effectually promoted by the continued
maintainance of two or more separate boards of medical examiners, in
order that the several schools may be untrammelled by the supervision '
of the representatives of opposing systems, , which an association in a
single board necessarily involves ; also, in order that each school may
be free to exercise its judicial and executive functions subject only to
non-sectarian and non -professional control.

Resolved, That to this end, we endorse the efforts made by the com-
mittee on Legislation of the State Homoeopathic Medical Society, to
prevent the repeal of the law of 1872, which provides for the appoint-
ment of separate State boards of medical examiners for the several
schools ; and that we urge the committee of the State Society to con-
tinue to put forth all reasonable effort for the preservation of the lib-
eral and equitable provisions embodied in this law.

Resolved, That we hereby respectfully request the members of the
Assembly from this county and the Senator from this district, to sup-
port the sentiments herein expressed, by opposing all bills which pro-
vide for a single State examining and licensing board, such enactments
constituting an objectionable form of class legislation.

Resolved, That we also heartily endorse the sentiment approved by
the University Convocation, at its last annual session, to the effect that,
u In the judgment of this Convocation, the power to license physi-
cians should be vested in boards of examination different from facul-
ties of medical instruction : " hence we recommend an amendment of
the law of 1872, which, while preserving its requirements regarding
the appointment of separate boards for the several schools of medicine,
shall also provide for the withdrawal from the medical colleges of the
right to grant licenses to practice medicine or surgery in this State
(the colleges being private institutions); thereby placing the licensing
power where it properly belongs, under the control of the profession,
in charge of licensing boards created for that purpose.

On motion the report was accepted and the recommendations adopted.
No report was presented from the Committee on Medical
'ation.

Thirty Sixth Annual Meeting. 45

REPORT OF MEDICAL SOCIETIES AND INSTITUTIONS.
The report was presented by M. O. Terry, M. D., Chairman.

Statistics of the State Homoeopathic Asylum at Middietown, Orange Co., N. Y.,

for the year ending September 30, 1886.

Patients remaining in Asylum, Sept. 30, 1885,
* Admitted within the year, -
Whole number of cases treated within the year,
Number discharged within the year, -
viz : as recovered, - . -

improved,

unimproved, -
Deaths, - _.....
Patients remaining Sept. 30, 1886,
Maximum number within the year,
Minimum " " ik -
Daily average,

Percentage of recoveries on number discharged,
Percentage of deaths on number treated, -

MALES.

FEMALES

174

181

101

112

275

293

193

218

l»«ftt

213H*

355

213

568

157

411

460

355

410

50.95
2.99

Report for 1886 of Homoeopathic Hospital, W. I., New York.

Dear Doctor :

I send you herewith report of our hospital for 1886 :

Whole number under treatment,

Number discharged — Cured, • - 1,487

Improved, - - - 1,399

Unimproved, - 176

Died, ------ 279

[Remaining January 1st, 1887, -----
Mortality 7.47 per cent.

Of this number 2,104 were in Medical Wards.

1,239 " Surgical Wards.
119 fcfc Erysipelas Wards.
65 " Gyn ecological Wards.
136 " Venereal Wards.
70 " Ophthalmic Wards.
45% of deaths were from Phthisis, in various forms.
7.8% u " Pneumonia.

10% ib " Heart troubles.

20% " " Kidney diseases.

fcfc

fcb

,733

3,341
392

46 Proceedings.

Since September, 1875, 1,137 cases of Erysipelas have been under
treatment at this hospital Of this number 31 have died, or a mor-
tality of 2.7 per cent.

Yours fraternal] v,

T. M. Stbono.

REPORT OF COMMITTEE ON PRESIDENT'S ADDRESS.

The Committee to whom was referred the address of the President,
delivered at the Annual Meeting, Feb. 8, 1887, would respectfully
report : '

That we are in full accord with the suggestion of the President as
to the propriety of still adhering to our organizations, both State and
National, having a hope, however, that the time may arrive when,
without betraying the trust, as guardians of the great law of nature,
which we have organized ourselves to develop and sustain, we may
enter into a larger and nobler union, where the only aim shall be
the evolution of truth, and the uniting of ties in the great brother-
hood of medicine.

The Committee also suggest that the Society approve the recom
mendation of the President that the Transactions of the Society be
published in two parts, to be bound in paper, immediately after the
semi-annual, and annual meetings, respectively, and that the license
given to the writers of papers read before the Society, to print them
elsewhere than in our Transactions, be rescinded, and that hereafter
they be the property of the Society.

While it is undoubtedly true that the work of the secretary is.
laborious and unquestionably deserving of the very proper remunera-
tion that it has hitherto carried, still, in view of the state of our
finances as exhibited through our treasurer, we recommend that for
the present the office of our secretary be not a salaried one.

Further than this, the Committee fully sympathize with the Presi-
dent in his remarks as to liberty of professional action, and tender him
our thanks for his earnest efforts in our behalf during his administra-
tion, by his public utterances.

J. J. Mitchell,

E. Hasbrouck,
George E. Gorham.

Report received and recommendations adopted.

Thirty-Sixth Annual Meeting. 47

REPORT OF DELEGATES.

Dr. Anna C. Howland presented the following report :

The Twenty-Second Annual Session of the Homoeopathic Medical
Society of Pennsylvania, was held in Philadelphia, September
20th-23d, 1886. The ceremonies attending the formal opening
and dedication of the new building of Hahnemann College, occupying
the rest of the week. The sessions which were held in the new col-
lege building were well attended throughout by physicians from all
parts of the State, who mainly devoted the entire week to the meeting.

Contrary to the notions of most New Yorkers, the Pennsylvanians
firstly disposed of the business part of the meeting in short order,
leaving only the election of officers until the last session, and then
spending very little time on that.

The rest of the sessions were wholly devoted to ^he reading of
exceedingly interesting and practical papers, which were received with
attention and actively and intelligently discussed.

Every bureau presented 6ix or seven papers. Almost none were
read by title only.

The deliberation and careful attention given to matters of the
most importance in meetings of this kind, viz,, the reading and dis-
cussion of papers, forms an example by which any of the State Socie-
ties in my acquaintance might profit. Your delegate was received
with marked cordiality and courtesy.

The new college building on Broad Street is an extremely handsome
one, and furnishes many facilities hitherto impossible in the old quar-
ters of the College. Respectfully submitted,

Anna C. Howland.

A communication was received from Dr. D. B. Whittier, of Fitch
burg, Mass., returning thanks for his election as an honorary member
of the Society.

REPORT OF THE NECROLOGIST.

Presented by A. W. Holden, M. D.

Albany, February 8th, 1887.
I beg permission to report by title the following names of record for
the necrological report for the past year, namely :

Dr. Thomas J. Pettit, of Fort Plain, N. Y., March 3, 1886.
Cornelius Ormes, M. D., of Jamestown, N. Y., April 20, 1886.
C. M. Lawrence, M. D., of Port Jervis, N. Y., Sept. 30, 1886.
Carl T. Liebold, M. D., of New York City, Nov. 30, 1886.

48 ■ Proceedings.

If any of the members present should be cognizant of the death of
any member of the State Society during the past year, not here
mentioned, they will confer a favor by reporting the same with sufficient
data for a biographical sketch to A. W. Holden, M. D., at Glens Falls,
N. Y., immediately.

REPORT OF THE COMMITTEE ON TESTS OF HIGH
ATTENUATIONS.

In the absence of the Chairman, the report was presented by Db.
H. M. Paine.

The committee appointed to enter upon tests of high attenuations,
would respectfully report that on approaching the subject, they found
difficulty in formulating any plan of work that could be easily made
practical, commend itself to the profession, and give decisive results.

In common with a similar committee of the Western New York
Homoeopathic Medical Society, we took time to discuss the subject
carefully, in all its respects. f

In the Autumn, the committee issued a circular to the profession,
through three or four prominent homoeopathic journals, and later on,
another circular with blanks asking the cooperation of the profession
individually, in filling out these blanks as proper cases occur.

As far as addresses were attainable, each homceopathic physician in
New York and several outside the State, have been supplied with
these blanks, hence it is not necessary to repeat their substance here.
This subject is a matter of vital importance to homoeopathy and should
command the active support of every homoeopath ist in the State.

The few answers to circulars received up to this time would be of no
benefit in a report, without the hundreds that we expect to receive in
the next year or two.

As Drs. A. W. Dods and W. C. Latimer have taken an active part
in the work of this committee, we would propose that they be
formally added to the committee by a vote of the Society.
Respectfully submitted,

A. R. Wright,
H. M. Paine,
T. L. Brown.

On motion, the report was received and committee continued, with
the addition of Drs. W. C. Latimer and A. W. Dods.

Thirty-Sixth Annual Meeting. ±\)

REPORT OF COMMITTEE ON REGENTS' DEGREE.

The Committee on Regents' Degree presented the following report,
which was accepted :

Mr. President:

Your Committee beg leave to report that they have carefully con-
sidered the statute authorizing this Society to make nominations for
the Regents' Degree, and in their opinion the degree is designed to be
wholly honorary in character. This view is based upon Chapter
268 of the Laws of 1862. page 1101 Revised Statutes (new edition), in
which it is expressly stated that this degree shall not permit its holder
to practice either physic or surgery. This is consonant with the
following by-law, adopted by this Society at its regular meeting in
1876 :

"Resolved. That the Regents' Degree of the University of the
State of New York be couferred only upon gentlemen of eminence
in the profession."

F. Park Lewis, Chairman.

No report was received from the Bureau of Materia Medica.
In the absence of the Chairman, the Secretary presented the

REPORT OF THE BUREAU OF MENTAL AND NERVOUS DISEASES.

{For papers and discussion see bureau report.)

On motion, Dr. Gortqn was given permission to publish his paper
in one of the journals, in advance of its appearance in the Trans-
actions.

On motion of Dr. Coburn, Dr. L. R Wells was placed upon the
list of Senior Members, with dues remitted.

The resignations of Drs. O. E. Pratt and Anna C. IIowland were
accepted.

The following being live years in arrears, were dropped from the
roll : Drs. E. J. Morgan, Jr., John S. Linsley and Joseph Finch.

On motion of Dr. Moffat, the names of Drs. A. S. Ball, of Kew
York, and D. II. Eullard, of Glens Falls, were placed on the list of
Senior Members.

Dr. E. Hasbrouck, Chairman, presented the

REPORT OF THE BUREAU OF OBSTETRICS.

(For papers and discussion see bureau report.)

Pri ICKKDIXG8.

L 1 B p£J> / EvEXI>'G SESSION.
H. L. Waldo, M. D., Chairman, presented the

REPORT OF THE BUREAU OF CLINICAL MEDICINE.

{For papers and disc tension see bureau report.)

No reports were received from the Bureau of Otology and Z'ced-

No report front the Bureau of Gynieeoloyy.
No report from the Bureau of Vital Statistics.
Adjourned.

SECOND DAY— Wednesday. ,

Society called to order ;it ID a. si. President Houohton in the
chair.

Dr. F. Park Lewis presented the

REPORT OF THE BUREAU OF OPHTHALMOLOGY.

(For papers see bureau, report.')

Geo. M. Dillow, M. D., Chairman, presented

REPORT OF THE BUREAU OF LARYNGOLOGY

[For papers and discussion see bureau report.)
No report from the Bureau of Climatology.

ELECTION OF OFFICERS.

The tellers announced that the following had been elected to the
respective offices :

President — II. M. Paine, M. D., Albany.

1st Vice- President — Wm. Tod IIelmutii, M. D., New York City.

2nd Vice-President- — J. SI. Lee, II. D., Rochester.

3rd Vice-President— G. E. Gobhaji, M. D., Albany.

c- -Heruekt M. Daykoot, II. D., Rochester.

-E. S. Coburn, M. IX, Troy.

CENSORS.

District — Drs. H olden, Pearsall, Laird.
District — Drs. Doughty, Hasbrouck, Norton.
istrict — Drs. Terry, C. E. Jones, Vincent.
district— Drs. Couch, Osborne, Wolcott.

Thirty-Sixth Annual Meeting. 51

On motion, it was voted that all necessary expenses of the office
of secretary be paid by the Society and that the secretary be requested
to make the expenses as low as possible.

J. M. Lee, M. D., Chairman, presented the

REPORT OF THE BUREAU OF SURGERY.

{For papers see bureau report.)

NOMINATIONS OF CANDIDATES FOR REGENTS' DEGREE.

The Committee reported the names of Profs. Wm. Tod Helmuth,
M. D., and Henry C. Houghton, M. D., as candidates for this degree,
and on motion, they were duly elected.

On motion, New York City was selected as the place for holding the
Semi- Annual Meeting, and the 20th and 21st of September as the time.

Drs. Helmuth, BEEBE'and Houghton were appointed a local com-
mittee of arrangements for the Semi-Annual Meeting.

The Committee on Chairmen of Bureaux reported the following,
which was accepted :

Committee on Legislation : Geo. E. Gorham, M. D., Albany.

" Medical Education : Chas. A. Bacon, M. D , New York City.

" Societies and Institutions: M. O. Terry, M. D., Utica.

Bureau of Materia Medica : Geo. M. Dillow, M. D., New York City.
" Ophthalmology : A. B. Norton, M. D., New York City.
" Mental and Nervous Diseases: Selden II. Talcott, M. D., Middletown.
" Histology : Fred S. Fulton, M. D., New York City.
" Obstetrics: Louis Faust, M. D., Schenectady.
'* Clinical Medicine : II. L. Waldo, M. D., West Troy.
Otology: L. M. Pratt, M D, Albany.
Predology : W. C. Latimer, M. D., Brooklyn.
" Laryngology: L. A. Bull, M. D., Buffalo.
" Surgery: J. M. Le «-, M. I)., Rochester.
44 Gynaecology : F. F. Lmrd, M. D., Utica.

Vital Statistics : A. R. Wright, M. D., Buffalo.
" Climatology : C. E. Jones, M. D., Albany.

On morion, a set of the Transactions was granted to the Hahne-
mannian Society of the Homoeopathic Medical College of New York.

On motion, the publishing committee was directed to include in
the coming semi-annual report, the president's address, together with
the minutes of the last semi-annual meeting, and the proceedings and
papers of the present session.

On motion, a vote of thanks was extended to the president and
secretary for the prompt and efficient discharge of their duties,
and to the members of the Council of the city of Albany for the
courtesy extended to the Society in granting them the use of the
Council room.

Adjourned.

52 Bureau of Mental and Nervous Diseases. »

REPORT

OF THE

BUREAU OF MENTAL AND NERVOUS DISEASES.

Samuel Lilienthal, M. D., Chairman^ - - New York City.

Drs. S. H. Talcott, Middletown.

A. P. Williamson. ----- Middletown.

C. Spencer Kinney, - Middletown.
F. S. Armstrong, - - Binghamton.

D. A. Gorton, ----- Brooklyn.
Wm. M. Butler, ----- Brooklyn.

OBSERVATIONS ON THE HOME TREATMENT OF

THE INSANE.

By David A. Gorton, M. D.,

BROOKLYN N. Y.

As to the necessity of asyhims for the insane there can be no two
opinions. But as to the propriety of sending every insane person to an
asylum there may be a difference of opinion. Under the system of
management now in vogue, though greatly improved over any former
system, for not long since insane asylums were merely institutions for
restraint and confinement of insane persons, it is a matter of fcoubt if
the highest degree of utility in the care and treatment of persons
suffering from any form of insanity is reached by them. On general
principles it must be conceded to be an error to herd diseased persons
together, whether it be persons suffering from brain disease, or any
other form of disease of grave nature — except it be in cases of the
hopelessly diseased — not only because the moral influence of such
diseased persons is bad upon each other, but also because the disorder
itself is aggravated thereby. Not to speak technically on this subject,
we may regard an insane person as suffering from infection. His
general condition is disordered. He is a walking morbus and a center
of morbific causes and impulses which are, in a measure, communicable
to others.

\ /

Bureau of Mental and Nervous Diseases.. 53

We are too prone to regard a person whose mind is disordered as
possessed of an anomalous affection. Nothing is further from the
truth, in most cases. In a large majority of cases insanity is nothing
but the mental effect produced by a general disorder in an individual
possessed of undue nervous susceptibility — or what is technically
known as an insane neurosis. The general health of such a person has
declined under the stress of ordinary morbific causes, and the bodily
functions have become impaired, and the brain receives the stress of
it. Perhaps it may be the liver that is at fault, or the kidneys ; or the
proximate cause may lie in the stomach, the lungs, heart or the sexual
organs ; not infrequently the cause is associated with defective function
of the skin, an instance of which we give in the report of a case sub-
joined herewith. But whatever the proximate cause or causes may be,
the general constitutional symptoms do not fail to reveal them in any
given case of mental disease. The excretions are morbid in every such
case.

Melancholia, for example, is usually traceable to disordered secretion
of the liver, and we believe properly so, for the biliary secretion is
abnormal ; but it is generally also associated with defects of the
functions of the skin, as seen not only in the yellow color of the skin,
but also in the absence of perspiration, or in the presence of morbid
sweat. Many persons suffering from pronounced melancholia have
come under my observation whose skin was as dry as parchment and as
rough as sand-paper, to whom a perspiration was an unknown phenom-
enon. The odor of their persons would nevertheless be fetid. In such
cases the restoration of the skin function is usually followed with
perfect relief of the mental disorder. So great, in fact, is dependence
of a sound mind upon a sound body that an unsound mind in a sound
body would be a strange phenomenon.

The celebrated writer and alienist, Griesinger, distinctly declares that
we shall find by due investigation that " nearly the whole pathology of
mental disease consists of mental perversions originating from internal
organic causes; and these perversions, in turn, give rise to insane ideas
conformable to the new mental disposition, and over which the most
various circumstances exert an influence." {Mental Pathology and
Therapeutics, p. 24.) And the same writer elsewhere observes, with
pertinent force, that " brain affections which lie at the root of mental
diseases are infinitely more frequently diffuse than localized." (Ibid, p. 6.)
So, likewise, he says, speaking of the treatment of disease of the mind,
that in no case of disease is " the desideratum strictly to keep in view
the individual of greater importance than in the treatment of insanity ;

54 Bureau of Mental and Nervous Diseases.

nowhere is the constant consciousness more necessary that it is not dis-
ease, but an individual patient ; that it is not mania, but an individual
who has become maniacal, that is the object of our treatment." (Ibid.
p. 4G4. ) Thus does this great writer and acute observer distinctly
assign mental diseases to the category of physical disease and enunciate
the same lucid doctrine as to the method of their investigation and
treatment. The doctrine, though not new to-day, is deserving of being
newly presented to the profession in general and to alienists in partic-
ular.

Diseases of the mind are, therefore, physical diseases, while at the
same time they are mental, and must be classified in the category of
morbific phenomena along with other bodily diseases. The laws of
cause and sequence are as operative with them as with all the disorders
of the bodily life. Nor do the pathology and therapeutics of insanity
differ, in principle^ method of investigation, or curative procedure,
from the pathology and therapeutics of diseases in general. The phy-
sician who is, therefore, properly qualified to investigate the nature of,
and to prescribe for, diseases of the lower organs of the body, is equally
well qualified to investigate and treat diseases of the organ of the mind.

It is idle to discriminate between parts and functions of the bodily
powers and processes, and to claim full knowledge in respect of some,
and complete ignorance in respect of others. Body and mind are one,
and he who is familiar with one is acquainted with the other, and he
who is ignorant of the one does not possess full knowledge of the other.

Holding this doctrine as firmly as we do, we have all along resisted
the tendency of the profession to drift into specialisms in any depart-
ment of therapeutics. For the same reason we have been opposed to
the policy of sending persons suffering from brain disease to asylums
for treatment so long as they could be properly taken care of at home in
the hands of the family physician. In general, he is the better custo-
dian of the case, if he be at all familiar with psychical disorders, as he
knows its natural history and is acquainted with the constitutional
peculiarities, idiosyncrasies of, and the remedies, sanitary measures, etc.,
the more likely to be suitable to the patient. Moreover, it must not be
forgotten, as Griesinger himself admits, " that the greater number of
insane do not require the confinement of an asylum ; that many of them
can safely be treated with more liberty than these institutions allow,
and that association in the family life is very beneficial to many insane
patients." — Mental Pathology and Therapeutics, p. 470.

To deprive a person of his liberty and confine him to the society of
lunatics simply, and for no other reason than because his brain has lost

Bureau of Mental and Nervous Diseases. 55

its balance or function, may be inflicting a double wrong. Such cases
are often as harmless as doves and as tractable as lambs, on whom the
restraint of an asylum would operate disastrously. Dr. Henry Maud-
Bley declares that from his own experience he cannot help feeling 4i that
one effect of asylums is to make some permanent lunatics. Continually
living in the atmosphere of the worst lunacy, certain patients seem to
become impregnated with its baneful inspiration, and, after a time,
sink to the situation. And I certainly call to mind," continues this
lucid writer, " more than one instance in which I thoroughly believe
that the removal of a patient from an asylum was the salvation of his
reason." {Physiology and Pathology of the Mind. First edition, p.
432.) The celebrated August Comte may be mentioned as a notable
instance of this, in point.

Such cases are exceptions, it may be said. But they are numerous
and deserving of notice. We concede that with most cases of insanity
home-treatment is impracticable. But deducting these cases, embrac-
ing the intractable and over-violent, the destructives, the suicides, the
homicides, and that large class of the insane who are unable to afford
the expense of being treated at home or privately, the remainder of
the insane would be infinitely better off under the care of their own
physician, in their own homes, the enjoyment of their freedom, and in
the society of their family and friends. Personal liberty is of such
priceless importance to anyone possessing brains enough to become
insane as to drive him mad who is deprived of it.

As great as the advantage of a non-restraint life is to an insane per-
son, there is another connected with it of still greater importance to
him ; he is in a sane moral atmosphere, exempt from the baleful influ-
ence of the society of the insane, which, as Dr. Maudsley says, often
serves to make permanent a case of slight gravity. Would you cure a
person of an infectious fever environed by an atmosphere of infection ?
Just as rational is it to undertake to cure a mind diseased in an envi-
ronment of lunatics. It is of signal advantage to one suffering from
a disordered mind to be associated with rational persons, and to be
dissociated from those who are suffering in a like or similar manner to
himself.

Another consideration in the therapeutics of insanity, and which is
too lightly regarded, is the importance of individual treatment of a
person whose mind is diseased, No method of treating any disorder
— much less that of insanity — can possess any claims to be regarded as
scientific which does not comprehend that of individualizing every case
under observation. The graded, or secundum artem method in treat-

56 Bureau of Mental and Nervous Diseases.

ing the sick — such as is pursued in the asylums and hospitals of the
old school, and is altogether too prevalent in those of the new
school — will not satisfy the principles of enlightened therapeutics
in the treatment of the insane, to-day. As Griesinger has pointed out,
it is a person whose mind is diseased that is the proper object of med-
ical treatment, rather than a case of mania or insanitv. But in insti-
tutions for the care of the insane, such a discrimination is impractica-
ble. The attending physician has not the time at his command to
study the symptoms and complications of each case and adopt a plan
of treatment conformable to the result of such a stud v. He has too
many patients under his charge for such a procedure. A course that
has been efficacious in one case must be applied to all similar cases. If,
for example, a certain nudicament has been found efficacious in quiet-
ing the wild restlessness and irritability of one maniacal subject, it is
apt to be prescribed to others, on purely empirical principles. As in
hospitals, so in the asylums. Empirical formulas are adopted for each
class of cases ; the results appear in the records, most carefully kept,
and iigure in the reiurns — in the statistics of percentages of deaths and
recoveries.

In home-treatment, on the other hand, it is possible to give the
patient the benefit of a scientific method — that of special individual-
ization. We say it is possible, although we know that such discrim-
ination in private practice is not always a reality, so easily does one fall
into empiricalism. The home physician is not likely to have so many
cases under advisement at the same time as to preclude his giving all
needed attention to each case. Should lie fail to do so, the failure
would be due to ignorance or indolence, rather than to lack of oppor-
tunity, for which state of things the friends or guardian of the patient
would be answerable equally with the physician ; for surely, there is no
excuse to-day for the employment of ignorant or unskillful physicians.

This brings us to one of the chief embarrassments that beset the
home-treatment of the insane, namely, the incompetency or aversion,
or both, of the average general practitioner to deal with mental mala-
dies. This state of things has led to an anomaly in practice, which, while
natural and inevitable, is nevertheless greatly to be deplored — the rise
of a class of specialist in mental diseases. Specialism in the therapeu-
tics of insanity has come, but we cannot believe that it has come to
stay. It has no reason to be except for the fact of the defective edu-
cation of ph} r sicians. With the correction of this evil, specialism will
have to go along with other ill-shapen creatures of misconception and
darkness. Some of our most prominent physicians — physicians pos-

Bureau of Mental and Nervous Diseases. 57

sessing large followings and having large experience in general practice
— make no attempt to conceal their ignorance of mental diseases, but
boldly disavow all knowledge of them. As unfortunate as such a con-
fession is, it is still more unfortunate that there should be intelligent
physicians who regard ignorance on such a subject as no drawback to
professional standing. It is, though, all the same. We cannot but
regard it as a serious evil, for the existence of which the college cur-
riculum must bear the responsibility. Let us hope, for the sake of
humanity and mental sanity, that the day is not distant when a Doctor
of Medicine may be equal to all the demands of his high calling, and
especially that he may be fitted to minister to a mind diseased, which
is the highest achievement of the medical art.

We conclude our observations on this subject by submitting a con-
densed report of

a case of acute melancholia.

We select f rom our experience in private practice this case of acute
melancholia, to illustrate the phenomena of mental derangement from
perversion of the lower bodily functions, and the success of home
treatment therewith : S. M., set. 31, blonde, unmarried, temperament
nervous. The young man was a devoted churchman, amiable disposi-
tion, of good habits and exemplary life, but with melancholic antece-
dents. His surroundings were congenial and happy. With the
exception of business anxiety, which was of no unusual character
among men of business, there seemed to be no mal-environment in
the aetiology of the case of sufficient moment to induce melancholia.
Nevertheless the attack came on.

Before consulting us lie had been treated by the physician of his
family to a course of Mercury, Quinine, Iron, Strychnine and the
bromides. Receiving no benefit from this, he consulted an alienist,
who prescribed a similar course of medication, and advised travel,
which were taken. His condition, however, continued to grow worse,
when, about six months from the beginning of the attack, he was
induced reluctantly to place himself in our charge.

We found him profoundly melancholic. Physically, there was
evidence of passive congestion of the liver. The skin was of a
yellowish color and dry — dry as parchment. There was constipation.
The urine showed the presence of bile pigment and seminal matter,
but was not albuminous. The appetite was capricious. There was
insomnia — chiefly after midnight. The temperature was usually one
degree above normal in the morning, the hour that we saw him.

5S Bureau ok Mental and Nervous Diseases.

Psychically, the patient was a great sufferer. He seemed enveloped
in a dense cloud of despondency. The powers of the unconscious
were greatly depressed. From being amiable and cheerful, he had
become taciturn and morose. He longed for death and had suicidal
impulses. From being a man of correct speech and pious impulses,
he had frequent attacks of irrational anger, during which he became
profane — weeping, lamenting and swearing by turns.

The nights of this patient were horrible. After the first sleep he
usually woke in a wild frenzy of despair — presenting psychical symp-
toms not unlike hvsteria. He had dread of solitude, and was constantlv
tormented with a sense of regret for something he had done or had
left undone. The impulse of 6elf-destruction was most marked in the
morning, to control which he was constantly watched by his faithful
mi roe.

The treatment to which we subjected him consisted of Chloride of
Mercury in \ grain doses, every four hours for three days ; after which
the same in l-50th grain doses four times a day, continued until some
effect of the drug was manifest in the stools ; after which Chamomilla
in tincture was given ; the latter was followed by Sulphur, 1st centesi-
mal potency. As an adjuvant or supplement to these medicaments,
Turkish baths were prescribed, at first, two a week ; later one a week.
The influence of the baths was most marked, in relieving the mental
depression and in promoting rest and sleep — an effect which was due.
it is rational to believe, to the favorable influence of the baths upon the
function of the skin, which in this case, as in manv similar cases under
my observation, was suspended. Be that as it may, the patient made a
good recovery, and homoeopathy gained a new convert and advocate.

Bureau of Mental and Nervous Diseases. 59

The Practical Treatment of the Insane.

By Selden I J. Talcott, M. D.

MIDDLETOWN, N. Y.

The insane must be cared for either at Lome or in suitable asylums :
or else they must be neglected and allowed to wander in the woods
and mountain fastnesses, as thev were at the time when the Healer of
Gennesaret performed his mighty mission. So long as the patient is
not dangerous to himself or others, so long as he or his friends have
the means and the willingness to employ ski J led nurses and able physi-
cians ; so long as the causes of insanity do not rest almost entirely
upon the irritations of his home surroundings, the insane man may be
cared for in his own home, or he may be looked after and maintained
in a private family, which is not his residence. But if the patient
becomes dangerous to himself or others, if his financial abilities fail, if
the exciting causes of insanity may be traced to the hardships of
business, the cares of every-day life, or to the frictions which some-
times arise at home by reason of incompatibilities or vexatious
burdens; if such care and treatment as are most likely to promote
recovery cannot be secured at home, then the patient may be 6ent to
an asylum where he may be at least maintained at reasonable cost, and,
if possible, cured, at the minimum expense, either to the public or to
his friends.

The honor of establishing the first asylum for the insane in the
world is due to the monks of Jerusalem, who in the sixth century
built a refuge and a home for the insane dwelling at the far East.
Southwestern Europe received its first asylum at the hands of a
begging monk, in, the fourteenth century. This monk was moved to
pity for the insane by seeing these unfortunates running about without
care or comfort, in the streets of Valencia, in Spain. To the Quaker
Christians of England is due the honor of improving the condition of
the insane, by converting madhouses into asylums for care and
treatment.

Wherever the light of the Gospel has penetrated the darkness of
sin and crime, there, in the light, and among the brightest and most
conspicuous evidences of Christianity, we find the towering walls of
asylums for the care and cure of the insane.

60 Bureau of Mental and Nervous Diseases.

Whoever seeks to decrv these institutions, whether influenced bv
personal spite, or greed for personal pelf, is an enemy to the teachings
of the Golden Rule. Whoever seeks to upbuild, to maintain, to
improve, and to promote the best interests of asylums for the insane,
is doing a work which would do honor to the memory of a John
Howard, of a George Peabody, a Florence Nightingale, or a Dorathea
Dix.

Nowhere in this world have insane asylums been built with greater
care, and nowhere has success in the treatment of the insane been
more manifest, than in these United States. Every State has its
asylum, and some of them have several, for the care and cure of this
most unfortunate class in the community. Millions of dollars have
been wisely, yet liberally, expended in this and other States for the
purposes aforenamed ; and the wisdom of the statesman continues to
respond to the demands of the people.

The laws for the protection of the insane have been thoroughly
investigated, and in this State carefully codified ; and in these laws we
find rules for the admission, retention, and discharge of all classes of
the insane. No man can restrain a lunatic outside of his own home in
any private house or in any asylum, unless that patient is duly com-
mitted according to law. No asylum can be opened until it has been
duly incorporated, and recognized by a special law. And no private
house can be used for the special detention and care of a lunatic*
unless that house has been first inspected and approved by the State
Commissioner in Lunacy, and a license granted by him. Whoever
treats a lunatic other than in accordance with the foregoing provisions
i« a law-breaker, and liable for damages for false imprisonment in
every case.

Many other States have made similar laws as those which are now in
vogue in the commonwealth of New York.

The measures for placing the insane under care and treatment
having been briefly explained, the next question arises : u What shall
be the treatment of those suffering under the visitation of insanity ?"

Wherever it is practicable, the insane person should be afforded the
benefits of a change of climate ; that is, those who have lived and become
insane in the valleys, in large cities, and along the sea-shore, should
be afforded the benefits of mountain air and inspiring scenery ; while
those who have come to suffer with insanity while living in mountain
regions, should be made to try the effects of the atmosphere and the
inspirations of the untiring, ever-changing, and constantly resounding
ocean.

Bureau of Mental and Nervous Diseases.

The insane should be placed in buildings which are, from a sanitary
point of view, above reproach. Fresh air should be constantly fur-
nished, and even temperature always maintained. To accomplish these
ends, the rooms should be large and the facilities for changing the air
frequently should be secured, and the heating of such rooms should
be by steam or by hot water, thus avoiding the irritations and the
dangers which arise from stoves that are constantly emitting more or
less the gases and other impurities from coal.

The personal measures to be adopted for the insane are, first, gentle
discipline, attended always by invariable kindness ; secondly, rest ;
thirdly, exercise ; fourthly, diet ; fifthly, mental and moral hygiene ;
and, sixthly, medicine.

Samuel Hahnemann recognized the necessity for kindness in his
treatment of Klockenbring, the celebrated Secretary of the Chancery
of Hanover. The immortal Hahnemann declared : " I never allow any
insane person to be punished by blows or corporeal inflictions, since
there can be no punishment where there is no sense of responsibility.
The physician of such unfortunate creatures ought to behave so as to
inspire them w T ith respect, and, at the same time, with confidence. He
should never feel offended at what they do, for an irresponsible person
can give no offence. "

The suggestions of Samuel Hahnemann are the key-note for treat-
ment in all cases of insanity.

It is difficult to meet insane people and listen to their torrents of
abuse sometimes, and still maintain an even temper. But if the person
caring for a lunatic remembers always the irresponsibility of the
patient he may then bear a serene front in the midst of terrible insane
abuse.

The insane are always sick. Therefore they always need the treat-
ment w T hicl vis commonly accorded to sick people. Under the influ-
ence of insanity the usual tendency is to undue excitement, and to
undue physical activity.

If the patient is wasting in physical strength under the encroach-
ment of his disease, he should be made to rest. He should obey Mac-
beth's command to Seyton : u Get thee to bed ! " And he should stay
there until the excitement has subsided, the irritations of disease have
been allayed, and the process of recuperation, both physical and men-
tal, has been thoroughly inaugurated. Then he may begin once more
the normal activities of life. These, however, should be resumed with
that caution which is enjoined by the old Latin saw, "Festina lente " —
make haste slowly.

62 Bureau of Mental and Nervous Diseases.

During the process of rest especial attention should be given to the
administration of diet. The insane bear, as a rule, large quantities of
liquid food. It has been our custom to administer liquid food, to weak
cases, once in three hours, from 6 a. m. to 9 p. m. Milk and beef
tea, the one as a nourishment and the other as a stimulant, seem to
make a happy combination in the diet of the insane. For solid food
at the outset, toasted bread, baked potatoes, and boiled rice or oatmeal
are all that may be necessary. As soon as a practical gain in weight
has been accomplished, then the patient may indulge in full quantities
of such food as he likes best, and such as agrees best with his physical
idiosyncrasies.

Rest and diet having been administered under the daily watchful
care of a good physician, until a positive gain has been made, then, by
his orders, the resumption of ordinary exercise may be slowly but suc-
cessfully carried on. During the long, tedious period of recuperation
there may come, first, the study of pictures, the reading of light peri-
odicals, and short conversations with friends. Each day of convales-
cence may bring an added privilege, until one may read a book, or
take a stroll with a trusted nurse or with a judicious friend.

The medical treatment of the insane under the homoeopathic plan
has been pursued in one of the asylums of this State for a baker's
dozen of years. That experiment has been eminently successful. There
has been a gradual increase in the recovery rate, and a decrease in the
death rate, at the institution at Middletown; until, during the year end-
ing September 30, 18St>, we find the recovery rate 50.95 upon the
whole number discharged, and the death rate 2.99 upon the whole
number treated.

In looking over the records of an asylum which has been established
more than forty years, in this State, we find that in the most favorable
year in the history of that institution there has not been a death rate
as light as that which was gained during the past year at Middletown.

The causes which have produced these results have been very
briefly outlined in this paper for the benefit of this Society. In addition
to the means already described, we have used homoeopathic remedies,
applied according to the doctrine Similia Siinilibus Cnrantur, and
we have used no other medical treatment among our patients. So long
as the results are better than those obtained by our allopathic
brethren, there can be no temptation to return to the " flesh-pots of
Egypt/'

The remedies most frequently applied for the cure of the insane are :
Aconite, Arsenicum, Belladonna, Hvoscyamus, Stramonium, Veratrura
album, and Veratrum viride.

Bureau of Mental and Nervous Diseases. 63

A second group, of perhaps a little less importance, are : Baptesia,
Bryonia, Cantharis, Chamomilla, Cimicifuga, Ignatia, Natrum muri-
aticum, Pulsatilla, and Sulphur.

These are some of the most common remedies ; but we seek always
in our prescriptions to find that remedy which covers the totality of
symptoms as presented by the patient. Acting upon this plan we feel
encouraged by the results of the past to keep on with our investiga-
tions and our experiments in the future ; until we have found better
and surer means for the cure of the insane.

As an illustration of the benefits of the rest treatment and suitable
diet, we present the following case, collated by Dr. Williamson, my
assistant, from our case books :

No. 1988 was admitted to the State Homoeopathic Asylum for the
Insane, December 10, 1886. The patient was a female ; age, 30 ;
single. She was of a nervous temperament, but had no history of an
inherited predisposition to insanity. About five years ago this patient
caught cold while menstruating, and the menses were suppressed. This
was the supposed cause of the present attack. During the past five
years this young lady had had repeated attacks of excitement, during
which she was very violent, and on one occasion had threatened to kill
a brother. When admitted to the asylum she was pale, weak, and
anaemic. She weighed ninety-one pounds; her pulse was 88, and
weak; her temperature was 100.02 ; respiration, 20 ; pupils, dilated ;
appetite, poor ; bowels, constipated ; menses, regular as to time,but very
profuse. The patient was, and had been, greatly troubled with
insomnia, and for two years previous to the asylum she had been able
to secure sleep only by ether inhalation, or chloroform,or by the use of
the hvdrate of chloral.

When admitted, the patient was very much excited, and quite noisy,
screaming about people applying electricity to her. Afterwards was
very tearful for several days.

Considering the cause, the condition, and the mental symptoms
presented, she received Pulsatilla. The patient was placed in bed, and
perfect rest enjoined. The diet ordered was hot milk, hot beef tea,
Mellin's food, and other easily digested nourishment, as the appetite
of the patient craved, such as broths of various kinds.

The day following admission the temperature of this patient had
returned to the normal. This patient remained, without restraint of
any sort, quietly in bed ; and on the 5th of January, 1887, she men-
struated without pain, without excessive flow, and without any return
of the delusions or mental excitement. While menstruating, the only

64 Bureau of Mental and Nervous Diseases.

abnormal exhibition was a tendency to weep in a quiet and subdued
manner.

On the fifteenth of January, about five weeks after admission,she was
allowed to sit up for the first time. The pain in the ovarian and
uterine regions, which had troubled her for about five years, had
entirely passed away. Since that time she has been able to walk about,
both in and out of doors, visiting the green-houses, and strolling around
the grounds as much as she wished.

February first, fifty days from the date of her admission, she weighed
114 pounds, a gain of 23 pounds. This patient now sleeps well, has a
good appetite, is in good spirits, and her mind is clear and free from
delusions.

-/ #

SOME DIAGNOSTIC POINTS IN NERVOUS

DISEASES.

By Chas. E. Walker, M. D.

WEST HENRIETTA, N. Y.

Perhaps no subject in medicine is more vague or misunderstood by
the profession at large than the symptomatology of nervous affections.

I do not expect to elucidate the few nervous phenomena that I shall
speak of to the entire satisfaction of those present, nor even to the
satisfaction of myself. I seek for more light and write with the hope
that these random thoughts may open up a mine of experience and
research from those older and wiser.

To accurately diagnose a disease of the nervous system the physician
must study his case carefully and arrive at conclusions slowly. Close
attention to details and a careful review of the case will often correct a
hasty diagnosis. The foundation of a correct diagnosis is a thorough
anatomical knowledge of the whole body, and a clear understanding of
the function and physiological behavior of the glandular system. A
deranged stomach, a perverted liver or an overturned uterus will often
set up a train of symptoms that might be mistaken for some grave
organic nerve lesion.

Bureau of Mental and Nervous Diseases. 65

To understand those diseases aright, demands the wide scope and
experience of the whole field of medicine as well as special study, both
in books and in the hospital. In studying the symptomatology of
nervous diseases, all symptoms may be grouped in two great classes :
Affections that depend on a destruction of the parts — organic diseases ;
and those functional derangements that depend upon perverted action
or mal-nutrition of the nervous organs or elements. Among the grand
characteristics which distinguish these two great classes of diseases, we
may notice that in organic lesions the symptoms are permanent and
uniform, the objective signs predominate, there is a gradual progress
toward a fatal termination, either with reference to life in general or
to that of parts or organs. (Lastly, the patient's mind is not occupied
so strongly with his own feelings and condition as in those diseases of a
functional type. The functional derangements are characterized by
indefinite and indescribable feelings. They are as transient and
flighty as the showers of an April day. One hour the patient thinks
death is after him and hastily summons his medical adviser, who,
perhaps, arrives to find his patient feeling as well as usual. The ,
subjective signs always take a prominent place in the history of every
case of functional nervous disease. Seguin, of New York, says : " The
Ego is very strongly and deeply affected, fear, depression and constant
dwelling upon the symptoms being prominent features."

These are general statements for the preliminary study of a case.
They are all liable to exceptions and each patient must be separately
considered. We must individualize our case, and while we, by so
doing, more quickly arrive at a correct diagnosis, we also are thereby the
better enabled to select the proper remedy for treatment.

Right here I wish to enter my protest against the statement often
made by members of the homoeopathic profession, that a diagnosis is
not a necessity to the proper treatment of a case. Symptoms are
all we need — and the indicated remedy. Where is the benefit of
remedies in a case of numbness of one side, with tingling of the fingers
and toes, and pressure and pain on top of the head % What would
Aconite or any other indicated remedy do when the whole train of
symptoms depended upon a dislocated uterus % What would be the
indicated remedy when a severe facial and orbital pain depended upon an
exostosis or a thickening of the periosteum i Let us have as good a
diagnosis as the science of medicine and patient and painstaking study
will give us ; then select our remedy according to the totality of the
symptoms and according to the law of Hahnemann. " Prove all things,
hold fast that which is good."

6ti Bureau of Mental and Nervous Diseases.

It must be borne in mind in studying our cases that what to-day
appears as a functional derangement chiefly indicated by subjective
phenomena, may, in a few months, present distinct signs of organic
changes in the nervous system. Sometimes, even after the most care-
ful study of our case, we cannot be sure as to the presence or absence
of organic changes.

Subjective symptoms are those sensations experienced by the patient
in the absence of any visible signs to the investigator. A patient
comes to you and says he has the jumping toothache. There are no
signs visible to the doctor that the patient has pain. The sensation is
purely subjective.

Objective phenomena are those 6igns which the physician can see
for himself, and knows the value of his observations. A patient is
seen with a hot skin, which is felt, a bounding pulse, which is counted,
a high temperature, which is indicated by the column of mercury.
These are objective symptoms. They require no words from the
patient to obtain them .

Of these two classes of signs the objective is far the more valuable.
On this class of symptoms the patient's imagination or his willingness
to deceive, can have no effect.

One of the commonest of subjective symptoms, and a -symptom that
appeals the strongest to the doctor for relief, is pain. What is pain ?
•Dunglison says, " It is a disagreeable Rensation that scarcely admits of
a definition." Stewart, of Edinburgh, says that " pain is the repre-
sentation in consciousness of certain impressions, or of an excessive
degree of any kind of sensory impression/' Those sensations that give
pleasure may by a continuation or in excess become a real pain.

Pain is always the result of an irritation. This irritation may be in
the nerve-endings, in the nerves themselves, in the cord or in the sen-
sory centers. Wherever the source of irritation may be, the pain is
always referred to the peripheral area of the sensory nerves.

No manifestation of pain is more common or more troublesome to
treat at times, than headaches.

Many forms of headache are symptomatic of some organic lesion
of the brain, as in tumors and exostoses. Headache is a constant attend-
ant of fevers. Headache occurs in the weak and thin -blooded person
from anaemia. Women are the most common sufferers of the anaemic
headache, and uterine diseases or disorders of menstruation are con-
nected with it. The pain is of a dull character, usually in the vertex
or temples. I have so often found a " top-headache " associated with
uterine trouble that I sometimes call it uterine headache.

Bureau of Mental and Nervous Diseases. 67

The sympathetic headache is closely allied to the foregoing in char-
acter and situation. It is generally connected with disorders of the
digestive and sexual organs. Many of us have experienced, after a
twelve or fourteen course banquet, in honor of the founder of our
school, that pleasant feeling — a morning headache, from gastric dis-
turbances. The headache of ovarian disease is familiar to all gynaecol-
ogists. Not only headaches but severe neuralgias in other remote
parts are known to arise from ovarian irritation. Professor Hay, of
Aberdeen, once had a patient that had for two years and a half, once a
month, at the menstrual epoch, an attack of earache so agonizing that
she screamed aloud and had to be held in bed. During the inter-
menstrual period she was perfectly well. The thought occurred to
the professor that the cause might be ovarian irritation. He produced
firm pressure over the ovaries and an immediate relief followed. I
have in mind a case in which there was extreme pain in the little
finger just before the catamenial flow appeared. As soon as the flow
was fully established, all pain ceased. This was undoubtedly a case of
reflux pain from an ovarian irritation.

There is a kind of headache that can be properly considered as sym-
pathetic, namely, over-straining of the eyes, either from improper
glasses or no glasses at all. Many persons have suffered for years from
headaches of this nature, without its being suspected. The fact has
long been known to oculists that disorders of the refractive apparatus
of the eye would give rise to cerebral discomfort and pain ; but physi-
cians in general practice are apt to overlook defects of the eyes to ex-
plain headaches where the causes are obscure. Weir Mitchell brought
these facts to prominent notice in 1874 and again in 1876. The points
made by him were — 1, that many headaches are caused indirectly by
defects of refraction or accommodation ; 2, that in these instances the
brain symptom is often the only prominent symptom of the eye
trouble, so that there may be no ocular pain, but the strain of the eye
muscles is expressed solely in frontal or occipital headaches ; 3, that
long continued eye troubles may be the unsuspected cause of insomnia,
vertigo and nausea ; 4, that in many cases the eye trouble becomes
suddenly injurious, owing to break-down in general health or to
increased sensitiveness of the brain from mental or moral causes.

There are various illusive sensations that form a prominent part in
the symptomatology of nervous affections. The girdle-pain, or belt
sensation, is one of these. It is a feeling as if a belt were tightly bound
around the thorax, abdomen, or other part.

The sensation does not go straight around the body, but obliquely in
a line of the distribution of some nerve. In direction it extends froia

*■

H8 UuREAU OF MkXTAL AND XeRVOI'8 DISEASES.

tlie back obliquely downwards and forwards. This symptom corre-
sponds in location to the altitude of the lesion in the spinal cord. In
progressive locomotor ataxia, when the lower segments of the cord
are diseased, the girdle sensation will be found in the hypogastric or
umbilical regions, as the lesions of the cord progresses upward, the belt
symptom travels upward, involving the thorax, and even the larynx.
The girdle pain is a common symptom of myelitis, acute and chronic,
and in locomotor ataxia.

Another common subjective symptom is the feeling of heat and cold.
A patient will say that one foot is intensely hot, while the other is ice-
cold. An examination of the parts will show the temperature to be natural.
The sensation of heat may be constant, or in flashes. Sometimes the
patient will describe a sensation as if a stream of some hot substance was
passing through the thorax and abdomen. Again, the patient will say
that something as cold as ice-water is dropping on the heart. A sensa-
tion of great coldness is more frequently felt in the legs. One of the
key-notes of the remedy, Sepia, is the feeling of wearing cold, damp
stockings. All are familiar with the hot flashes of the climacteric
period. They seem to pass like a hot wave from the feet to the head.
These symptoms are purely functional and transient in their duration.
•The origin and cause is not well known at present.

There are cases in which the objective symptom of rise of tempera-
ture is out of all due proportion to the feelings of the patient. There
are cases on record of hysterical hyperpyrexia where the temperature
has reached 110°, 115° and even 122° F., without any permanent
mischief following. The only way, says Stewart, of Edinburgh, in his
" Lectures of the Diseases of the Xervous System," that this astonish-
ingly high temperature can be accounted for, is, that there must be
some disturbance in the heat -regulating centre in the cortical layers of
the brain.

Another set of subjective sensations are the feelings described as
numbness, tingling, pins and needles, and formication. These
symptoms occur from changes in the nerve-endings, or from disease of
the nerve trunks. Well-marked cases are on record of paralysis of the
hands and feet as a result of temporary compression of nerve-trunks,
or from disease of the same. These symptoms are also seen frequently
in diseases of the cord and of the brain. A deranged stomach, a torpid
liver, and diseases of the sexual organs will often give rise to this same
train of symptoms.

In connection with those symptoms just mentioned, I will speak of
vertigo. This symptom almost arises to the dignity of a distinct

Bureau of Mental and Nervous Diseases. 69

disease. Weir Mitchell, in Pepper's System of Medicine, gives it a
consideration of about fifteen pages.

Vertigo is a feeling of uncertainty, a sense of defective equilibrium,
with or without actual disturbance of position, and accompanied by *
varying amounts of subjective feelings of motion of external objects,
of the body itself, or of the contents of the cranium.

Vertigo may arise from a great variety of causes. It may result
from external conditions, as in the dizziness of high altitudes. It may
be the result of certain toxic influences, as alcohol, tobacco, and stram,-
moniun. It is seen in the dizziness of sea-sickness, swinging, riding
backwards in a carriage.

It results from disease of the spinal cord, as can be seen in tabes
dorsalis, from disease of the cerebellum. AVothnagel says : " The most
characteristic symptoms of cerebellar disease are inco-ordination, a
titubating gait, and intense vertigo."

Vertigo is seen in nearly every organic disease of the nervous system,
and perhaps still more so in functional disorders. It is a prominent
symptom in some diseases of the eye, and more so in those of the ear.
Diseases of the stomach, liver and kidneys have vertigo classed among
their train of symptoms. Even disease of the larynx in certain forms
is said to have caused vertigo. Thus we see that that this symptom of
uncertainty is an ever-present one in numerous affections. Sometimes
difficult to find its cause, oftener troublesome to remove its effect.

DISCUSSION.

Dr. G. E. Gorham : I think the time is coming when we shall
find more organic defects to account for the now so-called functional
symptoms. Dr. F. N". Otis has shown us that many apparently func-
tional symptoms, coming and going, will be found to depend on organic
disease of the urethra. I believe the day will come when we will find
that the sympathetic nerve excitation at the orifices of the body is a
cause of many of the nervous symptoms which we now speak of as
functional conditions. About two years ago I saw a patient who had
suffered many things of many doctors, but without relief, who was
entirely cured of his nervous symptoms by slitting up the foreskin.
Another man suffered with pain in the tuber ischii and knees, had
become irritable and sleepless, and unable to do any mental or bodily

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Bureau of Mental and Nervous Diseases.

work, but was thoroughly cured by passing a sound through the
prostatic urethra. I believe that the rectum will be found to be one of
the richest fields for the discovery of these pathological lesions. I am
glad to hear the doctor make the prophecy he did.

Dr. T. L. Brown : It will be an interesting point, in these
nervous conditions, to discover whether the pain is in, say, the finger, or
in the brain. The course lesions in extremities made by wounds will
produce the local pain undoubtedly, but it is in the nervous diseases
themselves that this question can come up. What is pain, — a thought
or perception, and is it in the brain or in the spot subjectively located?
We must have some idea if pain is a thought, and there must be some
substance to produce pain, no matter where it is. The insane patients
must have something to make them think there is pain. We must
examine this question carefully, as it is an interesting one.

v. ' •.

1 t

REPORT

OF THK

BUREAU OF OBSTETRICS.

Everitt Hasbrol t ck, M. D., Chairman,
Drs. Wm. N. Guernsey,

Phocbe J. Waite, -

W. W. Blackman,

Henry Minton,

George E. Gorham, -

J. N. Tilden,

W r . II. Proctor,

Edwin Fancher, -

C. A. Groves, ....
J. W. Candee, - _ .
Wm. A. Allen, - - -

S. P. Burdick, - -

D. B. Stumpf, ....

Brooklyn.

New York City.

Brooklyn.

Albany.

Peekskill.

Binghamton.

Middletown.

Ticonderoga.

Syracuse.

Flushing.

Oakland, Cal.

Buffalo.

Disputants: Drs. L. L. Danforth, New York City.

J. Nicholas Mitchell, Philadelphia, Pa.

A CASE OF LABOR OBSTRUCTED BY A TUMOR.

By J. Nicholas Mitchell, M. D.,

PHILADELPHIA, PA.

In May of this year, I was requested by a friend, a man of large
experience in obstetrics, to see with him a lady who had been in labor
for some hours and who seemed, as he said, " to have neither cervix nor
08." When I reached the house I found that the patient had been in
labor some eight or nine Iioufs ; that the first symptoms of labor had
been the discharge of a dark fluid in sufficient quantity to make her

te'.ti"

>X , 72 Bujreau of Obstetrics.

v?** 1

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Ji'! nurse announce it as " the waters;'' that the pains were coming with
^.if great regularity and were excessively severe, and that a discharge of a

dark inoffensive character still continued. Upon vaginal examination,
$> s the vagina seemed to be a closed cul-de-sac, much shorter than usual ;

the roof and portion usually occupied by the uterus felt hard and
$$' resisting, and were not affected by the pains of the woman, and there
^ was no posterior cul-de-sac^ this space being filled in by this same hard,

f^< resisting body. Abdominal examination revealed two tumors in the

?i^, abdomen, each one running obliquely upwards in opposite directions

from the pelvis, and thus leaving a certain amount of space between
^ them at their upper extremity.

k .;v - The tumor running upwards in the left side of the abdomen was

V$-y found to grow hard under the hand when the pains came on, while
?>/J.'\ that on the right was unaffected by them. A second vaginal examina-
tion succeeded in passing two fingers between the symphysis pubis and
the hard presenting tumor, and with the tips of the fingers the os was
felt above the brim of the pelvis, partially dilated and to the right side.
J. Judging then that the tumor in the left side of the abdomen was the

y uterus with its cervix presenting thus at the right inquinal ring, the

V axis of the uterus was in such a position that if a straight rod had been

if-',;' passed through the abdominal wall to the right of the mons veneris
4 it would have entered the cervix at that place and have passed obliquely

' upwards across the abdomen to the other side. It was also discovered
<r.. v that the breech presented, and a diagnosis made of labor obstructed by
V , ' a tumor, probably ovarian. My first attempt was to push up the
X : tumor out of the pelvis and push the uterus and child down in its place.

After long continued effort in this direction without success, I
determined that one of two things must be done, viz : either tap the
tumor or perform a laparo-elytrotomy. Before attempting either of
i. these operations, however, we sent for further counsel. There was an

interval of time from 9:30 a. m. until 1:30 p. m. before we again met
with our added counsel. An examination revealed that during this
time some change had occurred which permitted the hand to be passed
by continued pressure between the symphysis and the tumor ; our
counsel advised against either tapping or cutting, and, himself, pulled
down the breech of the child, and, being tired with his efforts, left
I me to deliver the head and shoulders, which was done without any

great effort. The woman rallied very well from the operation and
ether, but had no contractions following the deliverv of the child. The
y placenta seemed to be entirely adherent since there was no hemorrhage.

|t During this time of waiting for the placenta, I again made an effort to

i ?i

^matiiAtmAiM^,-

Bureau of Obstetrics. 73

push up the tumor out of the pelvis, but was still unable to do so.
After waiting for a while, without contractions ensuing, friction over
the abdomen and medicines were resorted to, and a severe hemorrhage
coming on, the hand was passed into the uterus, and the placenta, which
was found partially adherent, was removed. The woman rallied well
from the labor, and after putting a few stitches into the torn perineum,
which needed no ether to perform, I left her some three hours after
the delivery, with a fairly good pulse, a temperature of 100.5°, with a
perfect consciousness and recovery from shock, and with a fairly-
contracted uterus. $ This was at 9 p. m.; at 6 a. m. the following day I
was called to her, and found her colorless, pulseless, and restless,
throwing her hands up over her head and gasping for breath, partially
conscious, and with cold and clammy extremities. The hand placed
upon the abdomen could discover the tumor in the right side of the
abdomen, but nt> uterus could be felt. I then discovered that no
discharge of blood had occurred externally since I had left. The woman
very shortly died. Unfortunately no post mortem examination was
allowed, but from the fact that I could feel no tumor, suggesting a
concealed internal hemorrhage, and that there had been no pains, and
no discharge externally, and knowing that she had rallied from the
shock of the delivery before I had left her on the evening before, I
concluded that there must have been a rupture of the uterus, and that
the constant flow of blood through this rupture had produced her
death.

I thought that she had rallied too completely from the shock for
that to be looked upon as the cause of death, and felt that if the tumor
had ruptured we should have had symptoms from the beginning, and
no rallying from the shock. AVhereas, I supposed that possibly the
laceration at first might not have extended through the peritoneum, or
might have been closed by the first contraction.

As an interesting fact it may be stated that I learned some weeks
afterwards that she was the third in her family who died from ovarian
tumors complicating labor.

Remarks. All authors agree that a tumor complicating labor and
obstructing the pelvis is of most serious import to both mother and
child. Anyone who has had to contend with such a case has the sub-
ject brought to his attention in such a way as to impress this fact upon
him more than any words or writing can possibly do. This makes the
third case in my experience. In both the others it was possible to
push the tumors up out of the way. One case then needing version
by the feet to effect delivery ; the other, after the tumor was pushed

$1 • •

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'74- Bureau of Obstetrics.

up, was delivered naturally. In both cases mothers and children
^ ' were saved.

Hodge notes as quoted from Cayeaux Puchell's statistics as follows:
Out of thirty-one cases, fifteen women and twenty-three children per*
ished. One woman and twenty-one children died during labor. In
five cases where no assistance was offered, four women and three
children died. In one case, the child and mother were saved by push-
ing up the tumor ; in a second case the child died but the mother sur-
vived. Version was performed twice — after pushing up the tumor —
both children and one mother perished. Puncture of the tumor was
made in three cases ; one woman escaped, two women and three chil-
dren died. Incision of the mass was performed in four cases ; three of
the mothers and one child survived ; one mother and three children
were lost. In one case, where the forceps was applied, the mother and
. child perished. Craniotomy was performed six times, three of the
mothers only recovering. The blunt hook was used in some cases,
with safety to both parties. Dr. Merriman reports eighteen cases :
Of these, nine mothers died, three recovered imperfectly and six
completely. Dr. Litzmann reports fifty-six cases ; twenty-four mothers
died and thirty-two recovered ; of the children seven were born alive,
thirty-five were still born and of the remainder no account wa6 given.

Playfair tabulates fifty-seven cases. In thirteen, labor was termin-
ated by the natural powers alone, but of these, six mothers, or nearly
half, died. In favorable contrast with these we have the cases in
which the size of the tumor was diminished by puncture. These are
nine in number, in all of which the mothers recovered, five out of the
six children being saved. The reason of the great mortality in the
former cases is apparently the bruising to which the tumor, even when
6mall enough to allow the child to be squeezed past it, is necessarily
subjected. This is extremely apt to set up a fatal form of diffuse
inflammation, the risk of which was long ago pointed out by Ashwell,
who draws a comparison between cases in which 6uch tumors have
been subjected to contusion and cases of strangulated hernia ; and th&
cause of death in both is doubtless very similar. This danger is
avoided when the tumor is punctured, so as to become flattened
between the head and the pelvic walls. On this account I think it
should be laid down as a rule that puncture should be performed in all
cases of ovarian tumor engaged in front of the presenting part, even
when it is of so small a size as not to preclude the possibility of deliv-
ery by the natural powers.

Barnes gives the following summary of Rules of Management of

Hor complicated with Tumors: " 1. Push the tumor above and

Bureau of Obstetrics. v 75

aside if possible. 2. If the tumor be fluid and it be thought better
not to attempt its removal, tap it by aspirator-trocar. 3. If solid,
puncture by aspirator-trocar, and if still undiminished in bulk,
remove it if possible. 4. If the tumor cannot be acted upon advanta-
geously, reduce the bulk of the child. Turn, perforate, crush the head
by cephalotribe, reduce by lamination. 5. If neither tumor nor child
can be advantageously acted upon per vaginam, resort to the Caesarian
section.''

"As in our case nothing but an attempt to push up the tumor was
made and none of the other rules laid down above — though puncture
or laparo-elytrotomy, if that failed, was suggested by me, but overruled
at the consultation. It may be proper to say that labor had been going on
for so long a time before our consultant arrived that he thought that
the risk of infection was greater than the likelihood of damage by
compression, since so much more space presented for delivery by this
time than was found earlier in the labor.

The delivery of the child was remarkably easy considering how small
the space had seemed at first, but from the oblique position of the
uterus above the pelvis and lying across the tumor, the pressure of
bringing the child into the axis of the pelvis was brought to bear upon
the posterior wall of the uterus, by having to pull at right angles to
the axis of the uterus, and across the tumor like a lever below, and I
fear that the strain was too great and resulted in a laceration of the
posterior wall of the cervix and that this laceration extended into the
body.

From my experience in this case I have determined that even when
there seems, as there did in this case finally, to be room enough to give
passage to the child, that if attempts to push up the tumor fail, either
puncture should be tried, or in case of failure to empty the sack, oper-
ation for removal of the child either by craniotomy or through the
abdominal walls by some one of the different operations, should be
attempted. In this case, from the position of the uterus, Thomas'
operation of laparo-elytrotomy suggested itself to me. Statistics of
craniotomy in these cases show very conclusively that the mortality is
as great as in Porro's operation under ordinary circumstances, so that I
should feel inclined to give the child the benefit of this latter opera-
tion, or, if practicable, of Thomas'.

Bureau of Obstetrics.

Obstetrical Memoranda and experiences.

By E. Hasbrouck, M. D.,

BROOKLYN, N. Y.

My practice began in March, 1805, and from that time until April
12th, 1869, was entirely within a farming district, where were
attended, probably, h'fty cases of obstetrics. My first case in Brooklyn
occurred April 23d, 1869. From that date until December 31st, 1886,
nine hundred and fifty-nine (959) cases have fallen into my hands.
The deliveries of thirty of these were attended for me by profes-
sional friends. Including premature births occurring after the sixth
month of gestation, the 959 cases yielded 971 children, of which 488
were males and 483 w T ere females.

The nativity of the parents is covered by the following table :

United States,

England,

Ireland,

Germany,

Scotland, -

Canada,

Sweden,

Wale*,

Norway, -

Holland,

Prussia,

Cuba,

The cases were distributed through the months of the years as
follows : During

Mothers.

Fathers.

Mothers.

Fathers.

698

625

West India Isles,

- 88

117

France,

—

100

Belgium,

Denmark,

Switzerland,

- 11

Hungary,

India,

Greece,

—

Austria,

Prince Edward's

Island,

Finland,

January,

February,

March,

- 84.
63.

- 85.

April,
May, -
June,

- 62.
69.

- 84.

July, - - 103.
August, - 76.

September, - 71.

October,

November,

December,

- 110.

64.

- 90.

The largest number of cases in one month was thirteen. These
occurred during October, 1881. Twelve cases occurred during July,
1875. Eleven occurred in each of three other months. A record of
796 of the 959 cases presents the following as the hours during which
the births occurred : From

12 to 1

ji • aXI • i

32.

8 to 9 a. m.,

39.

4 to 5

P. M.,

32.

1 to 2

45.

9 to 10 "

40.

5 to 6

25.

2 to 3

36.

10 to 11 "

26.

6 to 7

24.

3 to 4

36.

11 to 12 "

21.

7 to 8

32.

4 to 5

50.

12 to 1 P. M.,

25.

8 to 9

27.

5 to 6

44.

1 to 2 "

26.

9 to 10

24.

6 to 7

34.

2 to 3 "

20.

10 to 11

43.

7 to 8

58.

3 to 4 "

24.

11 to 12

34.

Ik'KEAU of Obstetrics. 77

Tliese compilations were originally made during the summer of
1885. At that time the record presented the fact that the greatest
number of births had occurred between 7 and 8 a. m., and the smallest
number between 2 and 3 p. m. It will be observed that the record has
been extended for one vear and eight months, and that these hours are
yet credited with the largest and smallest number of births. The
records show that twenty-four of the children were still-born. The
true or supposed causes of death is not fully recorded, therefore no
attempt is made to classify or enumerate.

One child had complete imperforate anus, a defect which was not
discovered for more than twenty-four hours, when by lamp-light 1
made an unsuccessful operation for its relief, the child dying before
morning. Another child had an imperforate anus, for which nature
undertook to compensate by placing an outlet (about the size of a goose
quill) for the intestinal tract, within the vagina. This case was oper-
ated upon with only partial success. The child dying after several
weeks from inanition. Three other cases of malformations occurred,
"the particulars of which present features of interest. See Transac-
tions of this Society, Vol. XV., pp. 173 and 174.

Prolapse of funis is recorded seven times. One of the women
informed me that this complication had existed with her in three suc-
cessive labors. I have no recollection of having delivered a living
child when complete prolapse of cord was present. Seven versionsare
recorded, but I am certain that this number does not represent all the
cases in which I have performed the operation. Presentation of
shoulder or hand usually demanded the procedure.

Forceps were used twenty-three times with my own cases, and few
times in cases of other physicians. Prolonged labor from inefficient
pains w r as the usual incentive for forceps delivery. The Comstock
(St. Louis) forceps is the only kind used, no difficulty having been
experienced in application or use, except in one instance as will be
related later. Eleven breech presentations are recorded. A larger
number probably occurred. Memory leads me to say that probably a
majority of the cases resulted in the birth of living children. My first
" twin " case was met seven years after beginning practice. Twelve
are recorded, none of which presented features of special interest. In
one case there were two amniotic sacs, two placentas and two cords, but
usually one placenta with two cords were found. Puerperal
convulsions occurred five times. Seven mothers have died, viz : Two
from convulsions, two from metritis, one from probable rupture of the
uterus, one from pneumonia eighteen hours after delivery, the disease

Bureau of Obstetrics.

ent before the onset of labor. One who was excessively
jiid had had several light convulsions before, and two after
, was given Hyos, which seemed to prevent a recurrence,
proceeding satisfactorily, the forceps were applied, but failing
eliver, the aid of our colleague Dr. Henry Minton was
He first applied the Comstock forceps, and being unsuc-

delivering, applied those of another pattern. After
le and sufficient effort had been made with these we saw no

than craniotomy, which operation was skillfully performed
tor, and then, as the child was exceedingly large, it was not
mplete the delivery. The patient died during the second
auses of death being uraemia and shock. Placenta previa
our times, of which one was a central importation. Partial
i occurred twice successively with the 3ame patient. In no
as premature labor induced. The mothers recovered, all the
jeing still-born. Many cases of post- par turn hemorrhage

met, but fortunately, none proved fatal, all being easily
by the usual remedies and manipulation. The most severe

two of the internal variety. A curious case was one of
dry labor, during which not ten drops of fluid of any kind
larged. Of the truth of the assertion I am positive, as I was
ng before the membranes were broken. The child was the

ever handled by me, and" leads to the query — Is there a
jtween absence of amniotic fluid and fietal adipose develop-
*ne patient had mania after two successive pregnancies. Both
:re mild. The first soon subsided. The second continued
eight weeks. The woman has not since been pregnant, and
I in the enjoyment of fair health. With the presentation of
>ing there is a consciousness that it is without practical value,
y of passing interest as relating some of the obstetrical
is of one individual. It may be permissible to make the
that the number of cases reported will probably compare
with the number which lias occurred in the practice of any
najority of practitioners during the same length of time, and
t seems to have been a practice remarkably void of severe

[ am unable to report, as has been done by some obstetri-
: " no parturient has died," yet, judging from observations
practice of my immediate professional neighbors, and the
3 possessed of the character of the fatal cases, the list of
lot viewed with feelings of complete dejection.

Bureau of Obstetrics. 79

An attempt was made to add other points of interest by stating the
number of primipara and multipara — together with the ages of
mothers, oldest and youngest, and relative, but it was found that the
demands of the Health Board of our city for such memoranda were so
recent as to make the available material uninteresting.

Having trespassed upon your time and patience with non-practical
matter, permit the presentation, in an order not justified by text-books,
of some features of practical obstetrics.

It has been stated that my obstetrical practice is personally considered
remarkably void of complications. In making this statement, the
reference related mainly to events connected with the deliveries. It is
now added that diseases such as metritis, metro-peritonitis, cellulitis,
and septicaemia, etc., which sometimes attack the parturient woman,
have been so infrequent as to have led to the inference that, perhaps,
such results could safely be, principally, ascribed to the almost invari-
able use of Arnica.

Unless some other drug is plainly indicated, every parturient in my
care receives Arnica, first to sixth dilution, immediately after (and
sometimes before) the completion of labor. It is given, a dose every
hour during the first few hours, and continued at gradually lengthened
intervals, until my visit on the second day. Then Bryonia, 12 to 30, is
substituted, and continued until the lacteal secretion is established, and
the breasts in a normal condition. If by this time the bowels have not
been relieved, and there is no special urgency in that direction, then
Kux. vom., 12 to 30, is given, until that event occurs. It is acknowl-
edged that this method is routine practice, and not commendable for
its scientific quality, being only justified by a satisfaction which prob-
ably compares favorably with that secured by other methods. The fact
is emphasized that at all times in the treatment of these cases other
remedies have been given instead, as they were indicated.

DIAGNOSIS OF PRESENTATIONS.

Without desire to depreciate the value of correct anatomical knowl-
edge, and the instruction imparted by those whose function it is to
teach in colleges, or to instill a careless habit into the practice of any
colleague, I am led to inquire — what proportion of cephalic presenta-
tions are accurately diagnosed previous to the completion of the first
stage of labor i Personal experience compels the reply that the per-
centage is very small. To become accurate diagnosticians of presenta-
tions requires a cultivation of the sense of touch, and a keenness of
perception which is, perhaps, rarely reached by the average general
practitioner. Those of us who may not be endowed with such qualifi-

^•" 80 Bureau of Obstetrics.

.■y, cations soon learn tliat in cases without dystocia from deformed, or
p~ ' abnormally small pelves, the attempt to closely define the presentation
partakes more of a theoretical than a practical practice of obstetrical
art. It may also be added in this connection, that to diagnose between
'• . - cephalic and breech presentations, before the membranes are ruptured,
is not always as easily accomplished as we may have been taught or led
to infer.

LIGATION OF FTJNIS.

Professors and text-books have instructed that the ligature should not
be applied to a funis until pulsation shall have ceased. In early practice
jfv this teaching was rigidly adhered to, but as experience broadened, and

increased demands upon my time came, the rule was frequently
encroached upon, until now, perhaps not more than once in fifty times
has pulsation ceased before the funis receives its ligatures. It is some-
what difficult to correctly formulate an opinion as to the results of such
practice, but it is believed that no harm has arisen from it. The babies
have not been unusually subject to colic, nor has jaundice always
occurred, or have those cases of it which have been seen been particu-
larly severe and intractable. My custom is to apply two ligatures and
cut between them, although in some instances when the funis has been
of unusual length a single ligature was applied, the funis severed, and
a knot quickly tied on the placental end. The knot or ligature then,
except for cleanliness, is deemed to be of doubtful utility, believing
that to allow the placental blood-vessels to become empty will facilitate
the withdrawal of the placenta from the uterine cavity. Playfair differs
from this conclusion, and says that the second ligature " is, perhaps, of
some use by retaining the blood, and thus increasing the size of the
placenta, and favoring' its more ready expulsion by the uterine
contraction." In a few instances the funis has been severed without
previous ligation. In my judgment this practice has no special value as
a rule, and the undesirable soiling of the bed-linen is, at least, a feature
which provokes condemnation. The quantity of blood lost by this
method is comparatively small, a fluid ounce, probably, being a large
average.

MATERIAL OF LIGATURE.

Some books teach the use of, and many women are very particular
to secure a piece of " bobbin " for ligatures. As it may be twisted into
a cord, it is not entirely ^unsuitable. Twisted silk having too great a
degree of softness and smoothness, is much inferior. Twisted cotton or
linen thread is superior, but from the general character of material,
and ease of obtainment, nothing more completely fills all requirements
than a plain piece of the ordinary cotton twine of the stores.

iCjui...

Bureau of Obstetrics. 81

dressing of the funis.

The usual dressing has been a wrapping of old soft linen or muslin,
without scorching or the application of an oleaginous substance. In
some instances a square of white cotton wadding or batting has been
used, but no special value in the article itself has been recognized, yet
were it always obtainable it would be used, as its application is more
readily made, and exhibits a more business-like appearance.

KNOTS ON FUNIS.

Several instances of knotted funis have been met, and upon one
were two knots. The probable explanation of such knots is an unusual
length of the funis and a possible abnormal activity of the foetus.
Nothing especially practical has been learned from these cases, yet it
is worthy of remembrance that death of the foetus may possibly occni
from interruption of the circulation of blood through the funis by the
presence of a knot.

ADHESION OF PLACENTA.

We may in thought naturally follow the funis to its source and enter
upon a consideration of some topics connected with the placenta. In
my practice its retention from adhesion to the uterine wall has been a
rarity. Only one undoubted case can be recalled, this occurring during
my second year of practice. It is proverbial that this complication of
parturition, as also hour-glass contraction of the uterus, is most fre-
quently met with by students and recent graduates. The latter embar-
rassment was escaped in my early professional days, and has remained
undetected as opportunities and experience have become extended.

DELIVERY OF PLACENTA.

My custom is to place one hand upon the abdomen of the parturient
and await uterine contraction before attempting to extract the placenta.
Should the contractions prove feeble and inefficient the hand above is
used to steady the uterus while the other follows the funis up to the
os, or if needful, into the uterine cavity. No great degree of traction
is made on the cord in order to dislodge the placenta, preferring, if it
is not readily brought forward, and is engaged in the os, to press a
finger into the suostance, and by a rotary movement effect its with-
drawal. If the placenta cannot be thus easily removed and is lodged
higher up within the cavity, then the hand is gently passed through
the os, and grasping the placenta is carefully removed again. We
have been instructed to avoid entering the uterine cavity, and without
doubt such instruction embodies a degree of wisdom. Yet the pro-
cedure just mentioned has been practiced many times, having yet to

Bubbau av Obstktbics.

gnize results which have led to the conclusion that the
>ecially hazardous. There can he no donbt but that in
tances where the hand has thus been introduced, a pro
ture of time and patience on the part of both patient
would have secured the placenta without such proeed-
livery the placenta is usually examined to learn if it be
iou which is generally found to exist. Of course, there
s when small pieces were missing, then these were care-
r and removed when possible.

ler a moment and say that it Is surprising how much
aratively minute piece of retained placenta will some-
in a case at full term, or of premature labor after
month. It is a matter of personal experience at least,
these classes, retention of portions of the placenta tend
nsive lochia and septicaemia, while in those of premature
ing from the third to sixth months of gestation, the dan-
■e in the direction of hemorrhage, and very slightly

THE USB OF THE BANDAGE.

to be now a much less persistent demand by parturient
iss, than formerly, for the application of the obstetrical
i general demand on their part having for its basis the
if form." This basis I believe to be purely hypothetical,
unities have been embraced to interview women bur-
so-called " large stomachs," and learned by the confes-
■f those that the bandage had received careful applica-
ir lying-in periods. The conclusion arrived at is, that
not an active factor in obviating rotundity, and that if it
age case of midwifery a practical feature, it is the sap-
re ret retched abdominal parieties during the first few
very. Exceptionable cases will require the bandage for
antial reasons. The application of the bandage should
aoned until firm contraction of the uterus has taken
adage is omitted in every case where a willing consent
an be obtained, and of those with whom its use has been
iave demanded it at a subsequent labor. For those who
se a straight piece of thin unbleached muslin is applied,
which, according to thickness, is laid on the abdomen one
oft napkins, which give firm and gentle protection over
i insertion, as well as contributes to make the bandage
s abdomen.

Bureau op Obstetric®. 83

breech presentations.

It is a recognized fact that breecli presentations involve a greater
degree of danger to the foetus than do those of the ordinary cephalic
varieties. College instruction and early practice was to allow a labor
with breech presentation to proceed to delivery without interference
until the head was about to be born, then as dextrously and quickly as
possible complete the birth. A few years since a paper was written
and published by Dr. J. E. Clark, of Brooklyn, since which time the
suggestions given by him have been followed as closely as possible.
These are, to change, if possible before the completion of the first
stage of labor, all cases of breech into foot presentations. He divides
the cases into two classes :

1st, and most frequent, is a position where the legs are flexed upon
the thighs, which brings the feet very near the os uteri.

2nd. The legs are extended, carrying the feet near the fundus of
the uterus, by the side of the head. Cases of the latter class being
those which usually give trouble if left unchanged. Dr. Clark has
formulated the following rules of procedure :

1st. In introducing the hand into the uterus, use great gentleness
with firmness, and always support the fundus with the unoccupied hand.

2nd. Introduce the hand, the palmar surface of which will pass
readily along the posterior aspect of the thigh of the foetus.

3rd. Choose the foot most anterior.

4th. Never bring down but one foot, reasons obvious. It leaves
protection for cord and gives bulk for dilatation.

5th. Do not hasten the passage of the hips through the pelvis.
Secure all the dilatation possible.

6th. Guide the rotation of the child in its descent so that the abdo-
men is posterior in relation to the mother.

The method of Dr. Clark is commendable because it allows a fair
control of the delivery, permitting it to be hastened whenever desirable.

OABB OF THE PERINEUM.

Minute directions for the treatment of the perineum during labor
are to be found in many of the obstetrical text-books. No attempt
will be made to traverse the whole subject, allusions being made to
only two portions of it. The completion of labor is sometimes
delayed by thick and rigid perinei. In some instances this condition
has been overcome by bountiful applications of lard or vaseline thor-
oughly rubbed into both surfaces. In other instances similar inunc-
tions in connection with the application of cloths, which were wrung
out of very hot water, and frequently changed, havejsucceeded admir-

Bureau of Obstetrics.

ard to the so-called "support of the perineum," the
ery strongly fixed that the earlier teaching on this sub-
16, and that that procedure which is termed " support-
mi " renders no support at all. The usual directions are
>f the hand is to be covered with a folded napkin, and

with this upon the perineum at the time the strong
s of the uterus are forcing the head of the child against
The .use of the napkin is considered to be superfluous

as with it the necessary manipulation cannot so readily
I, moreover, place it on the hand as you may, it is quite
ie dislodged, and to slip up and cover the thin perineal
prevent a proper observation by tonch of the distended
believed that the perineum can be protected from latter-
re applied directly to its surface, then the bare hand is
Ie, and of the utility of even this, much honest doubt

the perineum has, by reason of the pressure of the
:come so thin and tense as to make laceration appear
jrent impulse and watchfulness will lead the attendant
as much of the effects of the pressure as may be possi-

ci re nm stances. My experience has not taught any
ch this result is as readily secured as to place the hand
perineal edge against the head of the child, milking
e of resistance chosen to be exercised, and thus in a
ng the impingement of the head from the perineum to

regulating the force of its propulsion. At the same
t is instructed to suspend making voluntary expulsive
Jie practice of this method, serious lacerations of the
not occurred. It is, however, believed that slight lacer-
ir under any form of treatment and remain undetected
. are examined visually instead of digitally.

forceps the practice has been to encieavor to remove
sossihle instance before the complete birth of the head,
inch procedure presents greater possibility of prevent-
>f the perineum. In a few instances the head has been
wn on the perineum, the forceps removed and head
lit perineal damage, only to see it seriously torn when
ame through. It is certain the worst cases of laceration
those brought about by the delivery of the shoulders.

EDUCATION OF THE HANDS.

time and paper have been used in setting forth
to which hand of the obstetrician shall be used in the

Bureau of Obstetrics. 85

performance of this or that obstetrical manipulation Such instructions
are believed to be fallacious, and have been entirely disregarded. The
obstetrical operator should alike educate both hands as far as possible,
and then the use of a particular hand will be entirely governed by the
position of the woman and such other circumstances as may be
presented in each instance.

RESUSCITATION OF STILL-BORN INFANTS.

With regret it must be stated that in every instance the attempts
made to restore to life newly-born infants, apparently dead, have
proved unsuccessful. In cases which seemed to offer a reasonable hope
of resuscitation nearly all the recommended methods have been
faithfully tried. The two following named methods have not been
used. First — The Indian method, which has quite a number of
advocates, who reside mainly in the West. It consists in placing an
apparently dead infant upon a warm woolen blanket, and removing it
as far from the bodv of the mother as the unsevered umbilical cord
will permit. The mother is then requested to take a few deep
inspirations. It is claimed that with every such inspiration the . child
will open its mouth, gasp and soon begin to breathe. This practice
was observed among an Indian tribe by Dr. Meisner, of Chicago, and
by him introduced to the profession. He claimed that the use of the
method is simply taking advantage of the physiological fact that in
utero the child breathes simultaneously with the mother. (?) Several
physicians have published reports of cases restored by this method.
Second — That known as the Schultz's method. In which the child is
held by the shoulders, the thumbs resting upon the thorax, the child's
head towards the operator and its anterior surface to the front ; it is
then swung upwards, so that its feet perform a revolution, and lie
between the head and the operator's body, the trunk being then in a
state of forced flexion. The original position is then resumed by a
reverse movement, and the repetition of these movements constitutes
the method.

DEATH AND RETENTION OF FCETUS.

Several cases have been met where death of the fcetus occurred
previous to the expiration of the full time of gestation. Mothers who
have sought advice as to the results and necessities of such a circum
stance have been counseled to wait for the appearance of symptoms of
septicemic infection, or the uterus set up action to expel the foetus.
The latter procedure has always occurred, and no septic manifestations
have been observed. The cases have been managed as labor with a

Br/BEAU OF ObSTETBICS.

t full term would have been. The length of time elapsing
death and expulsion of the foetus was from two to six
the patients did well, one passing through the experience
rice being under my care.

POST PAKTUBI KBMOBBHAOB.
>f post-partum hemorrhage have been easily controlled by
ternal and internal manipulation of the uterus, together
ministration of medicine, the usual prescription being
Have not resorted to the use of ice or intra-uterine
very hot water (110°). The subject being without special
itruction in my experience, would not now be referred to
3 purpose of re-directing attention to an article recently
! the profession, which, on account of accessibility, should
3d in connection with this sometimes formidable compli-
use of Vinegar for hemorrhage was brought to notice by
rigg, an English physician, who used it in both hospital
ractice, and relates the following particulars of one of his
patient belonged to a family of ' flooders.' Her mother
sr relatives had flooded to death. As soon as the child was
.a to flood. I expelled the placenta, and gave a wine-
legar. The uterus, which was very flaccid, and constantly
ice contracted firmly under my hand, and did not again
;h the hemorrhage continued to a moderate extent At
teen minutes I gave a second dose, about two- thirds of a
This soon arrested the hemorrhage, and the patient did
h instances it was given pure, without any water. I used
is beyond holding the uterus, and feel certain that such
ilte would not have been obtained with Ergot. The action
k> rapid that its use is not permissible before the placenta
yr fear of causing a retention of that body, and making
fficult." He gives other testimony, and draws an infer-
tile reports that vinegar is likely to prove to be one of
il remedies for post-partum hemorrhage.

USE OF F.ROOT.

ery seldom been used during this obstetrical experience,
lose, and particularly for the purpose of controlling

In those cases which have received doses of from one-
toonful of the fluid extracts, for the purpose of exciting

pains, its use has generally been found to be followed
msive lochia than has been present in cases in which the
used. The administration of a full dose of a fluid extract

Bureau of Qbstetjmcb. 87

of Ergot, as is taught and largely practiced by our old school brethren,
ifl a practice which my experience has shown to be unsound in teaching,
and uncalled for in execution, and, for worthy reasons, much to be
deprecated.

VAGINAL INJECTIONS.

It is well known that in these later days it is a prevalent practice with
accoucher3 to have the vagina washed out daily with some antiseptic
preparation, the most fashionable remedy being at present a solution
of the Mercuric chloride. This practice has never, with me, obtained
to any great extent. No case has been thus treated until a particularly
offensive lochia has been detected ; then injections of from ten to
twenty drops of a solution of Carbolic acid to the pint of tepid water
have been used once or twice daily, as indicated. The practice which
introduces the daily use of the vaginal injection of any kind with the
average case of obstetrics, is believed to be wrong in principle, and
decidedly objectionable to the parturient.

PBOLAPSB OF ANUS DUBING LABOR.

During labors which are severe and prolonged, the anus will some-
times be forced down and protruded to a greater or less degree. If,
after such a labor is completed, the parts are examined and the
protrusion carefully returned within the sphincter, the comfort of the
patient will be much enhanced, and a possibility of hemorrhoids greatly
obviated.

There are times when either because of the birth of a still-born child,
or death of the infant soon after birth, it becomes necessary to use
measures to control an excessive secretion of milk in order to prevent
mammary inflammation. If the child be still-born, it is better to pre-
vent the secretion if possible. This may oftentimes be done by giving
the breasts an absolute rest, no manipulation of any kind except the
application of pieces of muslin, each the circumference of a breast,
spread with a proprietary article known as Kierstead's Ointment, and
giving an internal remedy as indicated. Bryonia has been, with me,
more frequently used than any other drug. Regarding the ointment,
I have no other than practical knowledge, having used it for many
years with an almost unvarying success in cases in which it was desira-
ble to prevent or overcome an undue secretion of milk. So favorably
is its use regarded that it is believed that if the application be made
early no breast will go on to suppuration unless unduly handled. It is
always essential that the breasts be not allowed to sustain their own

88 Bureau of Obbtetrios.

weight, but should be well supported by adhesive straps or other
baudages. Breast pumps are useful, but not nearly so much so as they
are used, and unless used with extreme care, are pernicious instruments,
as undue or uneven pressure made upon the breasts with them may
produce traumatism. Should the breasts become very full, and by dis-
tension cause severe pain, the pump may have to be applied. Its use
should be continued only just enough to relieve the tension, and not
be applied oftener than once, or twice at most, in twenty-fours. If the
case be one in which the secretion of milk is already established the
patient will probably be much better served if two or more weeks is
taken to disperse it, than if it be done in as many days. It may be
added that the ointment is as useful an adjuvant at the usual time of
weaning as in the early stages of lactation. If the milk Bupply shall
have proved insufficient for the demands of the infant, my custom is to
instruct the mother to drink as much as she is able of the best milk she
can obtain. Ale, porter and similar fluids used for this purpose, are
deemed to be stimulants acting at the expense of other portions of the
body, and not comparable with milk as a supporter of the strength of
both mother and infant. Among the various medicines that are recom-
mended to promote lactation, none have proved as efficacious in my
hands as Calcarea carb., third centesimal trituration, a single dose, not
repeated iu less than two days, and not at all if an action from the dose
already given is discernible. Repetition of the dose has seldom been
necessary.

In closing this paper it is proper to state that its imperfections and
disjointedness are fully recognized. Many other points could have
been brought forward, possibly witli a degree of profit, and perhaps
some of the subjects offered might wisely have been omitted. Its pre-
sentation is for the purpose of arousing a comparison of thought and
experience.

DISCUSSION.

Dr. G. E. Gokman: In connection with the paper of Dr.
Mitchell's, I would report the following case : A lady was confined in
the hospital during the past summer, and her death was, at first,
somewhat of a mystery, since she had had a successful delivery, although
the labor bad been somewhat protracted. During labor the physician
in attendance thought there might be a second child in utero. There
was a lump in the uterus as large as my fist, which felt very much like

Bureau of Obstetrics. 89

the head of a child, and as the placenta still remained in the uterus, the
abdomen was large and added its appearance to the idea of there being
another child. The delivery of the placenta showed that there was not
another child. The diagnosis was then made that the case was com-
plicated with a uterine fibroid. The patient did well for two days and
then, without any hemorrhage or pronounced chill and with very little
fever, she passed into a stage of collapse and died. There did not
seem to be any assignable cause, unless it might be that of 6hock.
Post mortem examination showed an intra-mural fibroid tumor.

Dr. H. M. Dayfoot: I have listened with pleasure U* the very
interesting paper of Dr. Hasbrouck, and especially because many of
his practices are in accordance with my own. I suppose that no two
practitioners will go over a paper like this one and coincide with the
writer in every particular ; it is not to be expected, so that what 1 may
say in the discussion is only a statement of my own peculiar treatment
and not a criticism of the paper.

It has been almost a routine practice with me to give Arnica after the
birth of a child, unless symptoms called for some other drug. I give
the first or second decimal attenuation. I am very apt to follow this
with Bryonia.

In regard to ligation, it is my rule to wait until pulsation has ceased
before I tie the cord, with this exception, that if the child is still-born
I sever the cord at once.

My experience in regard to resuscitating still-born children has been
more pleasant than the writer of the paper. I think I know several
children now alive who were, at birth, to all intents and purposes dead.
By immersing the body first in hot and then in cold water, together
with manipulation and artificial respiration, I have generally succeeded
in producing respiration.

I have had several cases of adherent placenta, perhaps half a dozen
altogether, one of them being associated with hour glass contraction.
My practice has been to introduce the hand and separate the placenta.
I have been successful thus far, having had no other unfavorable result
than a tedious convalescence.

It is my practice after delivery to use the vaginal douche. I use it
at this time in every case, but not afterwards unless the symptoms
demand it. If the temperature rises to 101, or over, on the second or
third day, I use the douche, and in the majority of cases it will reduce
the temperature and abort the inflammation or threatened septicaemia.
If the temperature rises still higher I do not hesitate to wash out the
TUerus. In regard to supporting the perineum I agree with the writer

Bukeau of (Obstetrics.

liead of the child which needs to be supported and not the
When labor is too rapid, I make pressure upon the head to
acerations will occur sometimes, no matter what expedient*
>.

^er bad a ease of abscess of the breast. On the slightest
: the patient concerning the breast, I immediately apply
ie shape of a well fitting bandage. The remedy I use most
iternally is that recommended by Dr. Lozier, some years
y the Iodide of Potassium.

bandage after labor, because I think the patients feel and
and there ie no valid objection to its use. In regard to
lave found benefit from five drop doses of Castor oil, three
I do not make half as many examinations as I did in the
of my practice, but use anesthetics and forceps more

. Goeham : A few words in regard to lactation. I had
describe for a nursing mother on account of inal-nutrition,
her to use Mai tine. A few days later she reported that Bhe
ke it on account of the increased flow of milk, which was
ie child could take, causing pain in the breast. Since that

used this preparation with good results in cases where
want of proper supply of milk. I give a tablespoonful at

I have not seen a case where it has not increased the
the milk ; of its quality I cannot say, except that the child
ished by it.

meting of the medical society held in this city last week I
isure 6f listening to a paper by Prof. Fordyce Barker, in
ted that he had tested the use of vaginal douches for three
g at the same time careful comparisons of the temperatures-
ras that the temperature was found to be higher when the
re used than when they were not. He had therefore
heir use in all ordinary cases after labor.

. Waldo : I have seen one case of prolapse of the funis
hild was delivered alive. All attempts to replace the cord
ailing. The child breathed without difficulty, and required
t.

swhat surprised at the small number of cases in which the
pplied the forceps, only twenty three times, I believe. It
they could have been applied with advantage in a larger
sases. In 393 cases I have applied the forceps 55 times.

Bureau of Obstetrics. 01

I do not know that they have ever done any harm, on the contrary I feel
that they have saved the mothers many hours of pain. In a few cases
I thought their early application had saved the children from being
still-born. The use of the forceps is often delayed too long. If care-
fully and skillfully applied, and no undue force is used, they can do no
harm to mother or child.

In regard to the use of Arnica, I gave it in the first years of my prac-
tice, bnt I do not use it now, unless it is especially called for, and I can-
not see but that the cases get along quite as well. I sometimes give a
few drops of Ergot in a glass of water, as much for the moral effect as
anything else. At times Gelsemium is used for after-pains. For the
constipation which is apt to exist in the first few days, I give Is ux
vomica and employ enemata.

In one case of prolapsed funis, rigor mortis was fully developed
when the child was born, the limbs being rigid. In two previous deliv-
eries of this same mother there had been prolapse of the cord. I
have not been able to find any record of a similar case of rigor mortis
developed at birth. In regard to resuscitation of the child, I remem-
ber two instances where I was called in counsel, in one instance to apply
forceps, and in the other to turn. The children were restored by the
vigorous efforts of the attending physician. One child lived twenty-four
hours, and the other is still alive, now two years of age. He placed a
handkerchief over the mouth of the child, and while raising its arms
breathed vigorously into its lungs. After repeating these efforts until
some life was manifest, a few drops of brandy, and afterwards Nitrite of
Ainyl were placed upon the handkerchief, and these seemed to aid very
much. Alternate warm and cold baths were used, and very brisk fric-
tion was made to the spine with. brandy. Efforts were continued for
three-quarters of an hour before respiration was fully established, there
being only occasional breathing up to that time.

I have seen but few cases of post-partum hemorrhage. I think that
this is due to the fact that I carefully watch the uterus, and if I find it
rising up in the abdominal cavity, I keep up vigorous friction over it
until I feel it contract under my hand. I continue this, sometimes for
an hour, giving it no opportunity to dilate. I also examine and clear
away any clots which may have accumulated. In a few instances I
have introduced the hand and made brisk friction on the inner surface
of the uterus. I am especially watchful for flooding where the pulse
is at or above 100 per minute and irregular in rhythm.

In regard to antiseptic injections I have not prescribed them myself
but some of the nurses in charge of my patients have made occasional

:'>*

■I

92 Bureau of Obstetrics.

use of them. I have not seen any special results from them, but from
my reading and the experience of my neighbors, I have come to regard
them with disfavor. I had two deaths in the 393 cases ; one from
post-partum hemorrhage with collapse, and the other from convulsions
caused by albuminuria.

,Dr. J. L. Moffat: In regard to the care of the perineum, I reraem.
her one case where the external orifice of the vagina was small, the
patient having been in labor for a long time, and where the head had
been pressing on the perineum for one or more hours. Fearing that a
rupture would occur, and reasoning that a cut surface would heal
quicker than a torn one, I applied a few drops of Cocaine to the parts,
and made a cut into it with a bistoury. The delivery was immediately
effected, and I then adapted the cut edges with serrefines, the wound
healing promptly. I think this might be a legitimate procedure in
some cases. I have found free lubrication with oil between the head
and perineum to be of benefit in some cases.

My routine practice is Arnica, unless the patient's nerves are
unstrung. I then give Chamomilla.

In regard to the use of the bandage, I think it gives comfort, when
you have a reliable nurse to put it on, but otherwise I get along with-
out it. I refer to the changing or readjustment of the bandage ; its
first application I superintend myself.

Dr. T. L. Brown : I have made it a rule in my practice not to
• attend a case of midwifery unless I have had an opportunity for
preparatory treatment. I want to direct their daily hygienic and
dietetic course. For the plainer they live, the more regular the exer-
cise, together with thp avoidance of all stimulating food and drink, the
better will they go through their labor. I use very little medicine in
these cases. You will seldom have laceration of the cervix, or other
troubles, when the patient has been previously prepared. If you let
them do as they please, you have a predisposing cause for innumerable
troubles always threatening. In an obstetric practice of fair propor-
tion I have not seen a bad case, and never had but one laceration. As
a lubricant I use lard instead of oil. I use it freely between the pains,
letting it run into the vagina as the head recedes, so that with each
pain the parts are thoroughly anointed. If the pains are regular, as they
should be in a normal labor, you will not have any laceration unless
the child's head is very large. We are not as good physicians if we
depend on the use of Arnica or Bryonia, under certain conditions, as
we would be if we tried to prevent the- occurrence of these conditions,
^here is a great difference between a physician and a doctor. I have

Bubeau of Obstetrics. 93

practiced midwifery in this way, not for the sake of homoeopathy, but
for the sake of being a physician ; homoeopathy will take care of itself,
but obstetrics will not. Take care of your patients day after day ; do
not take haphazard cases and have bad results. You can all do this if
you are firm in the matter, and let your patients know that you will
not attend them unless they give yon an opportunity to put them in
the best condition you can. They will soon see the benefits of it, and
will be glad to come to you. I have attended five cases this month,
and all did well. The physician for his own comfort, if not for the
patient, ought to be willing to instruct his patients in this matter. Is
it not better to have everything in readiness beforehand, than to run
the chances of trouble at the time of, or after labor? See how careful
the surgeon is in his minutest preparation of his patient, and why
should we not be as particular in midwifery ? I know whereof I
speak, and the man who will follow out this practice, will have a much
more comfortable time than will his neighbor, who does not do so.
The man who does not care to do this, should not practice medicine.
I have used the Phosphate of Potassium, 3d to 6th decimal, for an
offensive odor of the lochia, and in a few hours it would disappear. I
am not prepared to say that the remedy always made the cure, but in
other instances where the remedy was not used, the offensiveness
remained a much longer time.

Dr. Louis Faust : This is all very well in theory, but what are
we going to do when we are called to these cases ? Shall we say we
are not going to attend you because you did not give us an opportunity
to properly prepare you for the labor. Many times your regular
patrons do not inform you of the matter until labor is close at hand.
I would like to do just as Dr. Brown says, would like to have patients
call on me beforehand, would like to direct their daily care, but it is
not practicable.

As to cases of suspended animation, I have had quite a little experi-
ence in that emergency. Out of 700 to 800 cases of labor, I have had
six or seven cases of suspended animation, in only one of which was I
unsuccessful in restoring respiration. My method is somewhat similar
to that mentioned by Dr. Waldo, except that having cleansed the
mouth of the child, I blow directly into it with my own mouth.
Where there is any threatened trouble with the breast, I apply the
Iodide of Lead ointment ; one dram of Lead to the ounce of Vase-
line. In every case it has prevented inflammation. Where there is
a desire to lessen the flow of milk or suppress it, the Iodide lias also
proven serviceable.

5» • >

S**-

.>*:••

jMr Bureau of Obstetrics.

Br. L. A. Bull: I am surprised that nothing was said in the
paper about the use of Chloroform. I think its safety as an anaesthetic
in these eases, has been well proven. In regard to antiseptic washes, I
would like to ask if anyone has used Thymol. Prof. Carl Braun, of
Vienna, has used Thymol, in the proportion of 1 to 1,000, and con-
siders it, in particular, superior to Corrosive sublimate.

Dr. C. E. Walker : I believe in progressive medicine and pro-
gressive education ; I believe in the fact that our patients can be
educated to call upon us ante-partum. I have demonstrated to my
satisfaction, that a patient's condition can be materially benefitted by
treatment before parturition, and I thoroughly and heartily endorse
the statements of Dr. Brown in regard to this matter.

I use, ante-partum, plenty of Sweet oil, with Actea racemo6a
internally. I have found as an actual fact, that cases which have
always had difficult labors of from ten to fourteen or more hours
duration, have been able, by preparatory treatment, to shorten the hours
of labor and lessen the severity of the pains. I believe thoroughly in
this kind of treatment. We can easily educate our patients to
recognize the benefits to be derived from this treatment, so that they
will be anxious for it.

Dr. F. S. Fulton: I would like to say a word in regard to the
haemostatic action of Vinegar. I was sent for recently, in consultation,
to see a case where abortion was suspected. The patient was flowing
freely, anaemic, with face bloodless, and lips as gray as the cheeks. On
examination, a protruding body was found, but its exact nature could
not be definitely decided. The vagina was filled with clots. These
were cleared out with warm water, but the bleeding did not stop. I
then took a Davidson syringe, filled it with Vinegar and threw it
against the mass, when the hemorrhage ceased almost at once. The
next time it was syringed out there was no hemorrhage. Later exam-
ination showed that the mass was a degenerate fibroid polypus which
had been forced out by the internal contractions, and was bleeding. A
foetus of immature growth had been expelled, carrying down the mass
with it. The action of the Vinegar was very prompt.

In regard to Ergot I have noticed this point. A case of rigid os
with flagging pains, which were located mainly in the back, yielded to
Gelsemium, and wishing to increase the pains, I gave a few drops of
Ergot. It induced persistent, continuous pains, and also brought back
the rigid os, which felt like two hard contracted cords, one, just at the
external os, and the second, about one-quarter of an inch higher. This

■■' In .agitr .

Bureau of Obstetrics. 95

condition yielded to Belladonna, and the child was delivered without
farther trouble. I concluded that the administration of Ergot in the
first stage of labor, to hasten pains, was fraught with more harm than
good to the patient.

Dr. W. C. Latimer : In the early years of my practice I was
very much confused as to the treatment necessary to be followed in
confinement cases, taking the teachers' text books and answers to
questions asked many of the old physicians about these matters. I
finally decided to discard what they all said and begin investigations for
myself. So in the treatment of the cord I began by cutting without
tying, and found it a nasty piece of business. Then I tried tying
the cord twice and cutting between. I found that the children did
not do as well as when not tying the cord. Then I tried tying the
placental end of the cord, leaving the end attached to the child to bleed
for a time and then tying it. I found that here the results were aa
good to the child as when I cut without tying at all, namely, freedom
from colic and jaundice. On the other hand I found that the placenta
was. more easily delivered ; it seemed to come away more entire, leaving
fewer shreds behind it, and with less hemorrhage.

My next experiments were in relation to dressing the cord I used
scorched linen, and one thing after another, until I finally use exclu-
sively, a small square of absorbent cotton. I alwaj's carry it with me,
and I find that the funis dries up quicker under this dressing than
any other I have used.

I believe in educating your patients to seek treatment before con-
finement, and it can be done. I think ninety per cent, of my patients
engage my services some time before they expect to be confined.

The question of the dressing of the babe was also an important
matter with me. I now use only a Canton flannel slip or gown for the
early weeks. I dress the cord with the cotton and flannel binder, put
on a soft napkin, and then the Canton flannel gown ; that is all the
dressing needed for the first month. This is the instruction I always
give for the first child, afterwards they are willing to follow it without
instructions. The child rests much better in this dress, consequently
the mother rests better, and makes a better recovery.

I have been fortunate enough not to have much trouble with the
breasts, but where this has happened I have not had any benefit from
the use of Kierstead's ointment. The best results in my hands have
been obtained from the use of one-half to one dram of the tincture
of Belladonna to an ounce of Vaseline. That has saved many a breast
for mm.

Bureau of Obstetrics.

ed in haste to see a woman who had been confined, the
saying they conld not get the after-birth. She was a large
woman. The midwife in attendance had pulled off the
npting to remove the placenta. The latter was still in the
of the uterus, an hour-glass contraction being present. I

remove the placenta, after an hour's hard work; the
ie a good recovery. This is the only case of hour-glass
I have met.

[asbrouck: It is quite probable that an ingredient in
ointment is the Ext. of Belladonna.
ilso remark, that in my experience there is no department

in which people seem so penurious as in that of obstetrics.

the only time when they ask the physician, " How much
o cost J" They even try to beat you down. I feel that
Ices I get (twenty dollars and upwards), which includes the
it is the poorest paid service I render. In the interests of

think a law ought to be passed compelling every person
confined to notify a physician to that effect, at least two
ore confinement. They should become his patients from
nd lie should visit them at least once a week.
. Coburjt : I would like to ask if any of the members
y unpleasant results from the use of maternal washes, such
anate of Potash, Carbolic acid, etc. I got into the habit of

because others did. Things ran along on this line for
until one of my neighboring physicians, a member of the
^iad one of his patients die, on the third day after confine-
i child was taken to his grandparents and I was called to
en learned the following history : The physician thought

an nnpleasant odor about the patient and directed that an
lould be given. A fountain syringe was prepared, and as
egan to flow, the patient gave an exclamation and a groan,
id, almost before the tube could be withdrawn from the

id case was in my own practice. The babe was about five
lien we began to notice a slight odor to the discharges. I

as usual at about 11 a. m.; her temperature 99£, and
seemingly all right ; at 2 p. m., call came — they thought
ring to die." I found her with distended abdomen, intense
, quick rapid pulse. I asked the nurse as to the cause, and
; she had administered an injection of Carbolic acid water.

that not a bit of the water had returned. I made an

Bureau of Obstetrics. 97

examination, and found the os closed. Having a pair of placental
forceps with me, I, by degrees, introduced these into the womb, until
there was a gush of water. The thermometer at 6 p. m., that night,
was 104. After about three weeks of violent inflammation, my
patient made, what was to me, a very happy recovery.

It is unnecessary for me to add that I now never allow these washes
after confinement.

I have made use of several remedies, such as Maltine, Calcarea,
Bromo and others, for the purpose of increasing the flow of milk. I
have, however, a case where I want to stop the flow of milk, which
has now been running for four years. I have used all remedies and
every expedient, both external and internal, but without any result.
There is no hardness of the breast, no pain, only a feeling of fullness,
if the milk is not drawn off promptly. I have tried the experiment
of not drawing the milk, but the pain is soon so intense that we have
to resort to it.. The milk has to be drawn about once a dav.

Dr. Hasbrouck : I will try and help Dr. Coburn out with his case.
The physician who told me of the use of Calcarea, said also that it
must be used in the 3d centesimal, for if used in the 3d decimal, it
would decrease the milk. It seems to me there is some dyscrasia
involved in this case, and that there must be other symptoms to be
studied in this case, besides the excessive flow of milk. The remedy
for the totality of the symptoms will probably cure the case.

PN»- it..-.

Btr^

*V 1

:">••"

'S-

e*v

REPORT

OF THE

BUREAU OF CLINICAL MEDICINE.

H. L. Waldo, M. D., Chairman, ... - West Troy.

Drs. George E. Gorham, - Albany.

R. F. Benson, --.... Troy.

F. L. Vincent, ._.... Trov.

S. N. Brayton, - - - - - - Buffalo.

W. M. Decker, ------ Kingston.

T. D. Spencer, ------ Rochester.

W. C. Latimer, - Brooklyn.

C. F. Millspaugh, - Binghamton.

F. F. Laird, --..... Utica.

Disputants : Drs. Geo. E. Gorham, Thos. D. Spencer.

By H. L. Waldo, M. D.,

WEST TROY, N. Y.

In the present state of sanitary and medical knowledge, and before
such a Society as this, it would seem almost as though an apology
were due for presenting for consideration such a worn out subject as
the above, or for presuming to take the time of medical gentlemen in
discussing a subject which has been so ably and exhaustively handled
by so many of our profession.

My only apology is that the laity, almost without exception, and our
profession, in a great majority of instances, live in utter disregard of
the facts relating to the contamination of drinking water, and have no
idea of the importance of a pure water supply. Large cities are
wholly supplied from a river which not only contains the sewage
made in the city itself, but contains all the sewage of large cities
but a few miles distant, and members of our profession can be found
who are willing to say that no danger is likely to result from the use

Drinking Water as a vehicle for con- j
veying the germs of disease.

Bureau of Clinical Medicine. 99

of such water. "Wells are dug within fifteen feet of sewers and old
wooden drains, and within a few yards of privy vaults, and medical
men of my acquantance say that they are fit to use.

A medical friend of mine was called several miles into the country
to see, in consultation, an entire family sick with typhoid fever. lie
took dinner at the house and drank several glasses of water from the
family well ; as a result he had a long siege of typhoid. When asked
how he had been exposed, he could not tell, and the dangers of drink-
ing water from this well had never occurred to him, until they were
pointed out by a medical friend weeks afterwards. These are my
reasons for calling your attention to this much discussed subject.

I think that there is no longer any medical man who doubts that
typhoid fever and choiora are contracted by breathing or swallowing
the germs which have been contained in the excrement of former sub-
jects of the disease. That these diseases never originate de novo, I
shall not at present assert, but that, when once they are in existence,
they are communicated, as I have indicated above, I believe no one
will dispute. There is a city in this State of nearly one hundred
thousand inhabitants, which for years has had a water supply from a
river. From three to five miles above this city is situated a population
of over one hundred thousand which has a very complete system of
sewers into which are discharged thousands of water closets, besides
all the washings of streets and all the filth of a great city. Think of
the millions of intestinal parasites which are annually discharged
through these sewers. Hundreds of cases of typhoid fever occur
annually in this city, the discharges from which are thrown into these
sewers. How can it be possible that the city below can escape drink-
ing these parasites and germs. It is well known that they retain their
vitality for weeks and months. It has been demonstrated beyond dis-
cussion that diluting the fluid which conducts them does not destroy
their vitality, and exposure to the air increases rather than diminishes
their virulence. How many germs of typhoid fever would it be neces-
sary to swallow to produce the disease ? How many particles of cuticle
from a scarlet fever patient would be required to start a new case ?
These germs would be transported from one city to the other in a few
hours. Experiments and careful observations made in Europe by the
best experts in the world, have demonstrated that dilution of contam-
inated water does not greatly modify its power of conveying disease,
uid that after being carried one hundred miles, in a running stream,
t was as harmful as at the start. Recognizing this very fact, immense
urns of money are being spent this fall and winter, in England, to

Bureau of Clinical Medicine.

buildings and apparatus to disinfect and render harmless sew-
:i enters their rivers. I will not take the time of this
> cite, from medical literature, the hundreds of eases which
!Ord, where disease has been traced to a contamination of the
supply miles away. You are familiar with them.
>t which the laity almost universally commit, and into which
sion is likely to fall, is that of placing confidence upon the
a chemical analysis. It has been triumphantly asserted that
1 analysis has proven the waters of a certain stream to be pota-
liat therefore no further discussion is allowable. It has been
uimerous instances that disease has been conveyed by water
no adequate contamination could be detected by chemical
.nd in which the microscope failed to show the germ which
ischief. The only test for potable water should be absolute
rom sewage contamination.

; of the villages and in many of the cities of this country,
in frequent use. We almost invariably rind them located
iy regard to protecting them from drainage. I have seen
it a farm house, a well fifteen feet from a privy and no farther
place where all the slops were emptied. In West Troy the
ill of them in the gutters, and most of them at the corners
eets; at the present time, the stone work around one of them
isturbed, eight feet below the surface, in the construction of
nd yet a medical man who points out the dangers resulting
l sources is not believed, and is even accused of having at
tr motives than the public good. It is a common fallacy to
lat by passing through a few feet of earth water is relieved
luritics,

nsive epidemics of cholera and typhoid fever, it has often
;ed that only those persons were attacked who used a certain
ited water supply. Epidemics of cholera have been partic-
il and frequent in Holland, and it has been noticed by Ballot,
dam, that these epidemics have been confined to those sec-
re contaminated rivers, wells, or canals have been used as a
ply. In those sections of Holland where cistern water alone
lolera has never prevailed except as imported cases have

ir duty as physicians to take high and positive ground on this
We should never omit to call the attention of people to the
ley incur, and particularly when public works, which are to
ater for a large community, are being constructed.

Bureau of Clinical Medicine. • 101

is belladonna prophylactic in scarlet

Fever ?

By D. B. Whittier, M. D..

FITCHBURG, MA88.

I propose to present a few brief propositions concerning the zymo-
sis, the prophylaxis by Belladonna, and the popularly assigned methods
of infection in scarlet fever. In 1883, Dr. Couch, of your Society,
sought to procure a professional judgment upon the question ofVBella-
donna as a prophylactic in scarlet fever, and his decision was based
upon the majority of replies received. To the information, one hun-
dred replied affirmatively, and twenty-live negatively ; the doctor,
admitting the difficulty of submitting a satisfactory report, as the ques-
tion involved possible differences in types, isolation, exposure and
numerous other matters 'inherent in the subject. In view of the large
majority answering affirmatively, I, one of the small minority, em-
brace this opportunity for defending my position.

At first glance the report appears conclusive, but before being
accepted as the judgment of the profession, a stricter analysis of the
subject should have been entered upon. Judgments formed from
properly tested cases should be the basis, rather than from the opinions
of physicians. By the method adopted, the opinions of a physician
with a limited experience in this disease, and a careless analysis of his
cases, often counter-balance the observations of one whose deductions
are based upon a large experience, and an analytical comparison of cases
which fit him properly for the position of arbiter. Considering the
doubtful elements of ordinary clinical observations, does this decision,
based on the testimony of one hundred physicians, point an effective
prophylactic lance at scarlet fever ? I believe a thorough examination
of this subject will disprove the claim.

Zymoses. — It is conceded that scarlet fever is one of the best exam-
ples of zymotic disease. Prof. Allen says that this class of diseases is
never cured, but can only be conducted to a successful issue. Many
other physitian3 have maintained the same proposition. Should it be
thought that any one of the zymotic diseases has been arrested, a closer
investigation will show the fallacy of such an idea. For whatever evi-
dence of supposed convalescence is observed during the treatment, it will

Bureau of Clinical Medicine.

ards discovered that persons suffering from .such diseases will
.1 until the typical limitation lias expired. If, then, a zymotic
mot be arrested, can it be prevented; If an affirmative hypoth-
tertained, and a drug administered, what action obtains '(
that drug have an antipodal relation to the supposed approach-
i ? Admit the germ theory as a casual factor. Can the drug
ic germ either directly or indirectly ? Dr. Couch says,

then succeed in killing out a natural order in the vegetable
Sot at all ; it may be considered impossible to reverse any
igenoiis vegetable development. These germs have existed
d except from miraculous interposition, they always will exist.
) expect to banish them from the arena of nature is as absurd
1 be impossible." Deny this theory, and what morbid influ-
! drug sent to arrest ; Whose penetration is sufficiently acute
r the rational use of a drug without symptomatic, pathologic,

casual manifestations? It was Prof. Allen, I think, that
le organisms in perfectly healthy persons, and contended that
not detrimental to a healthy state.

axis. — Drugs have two actions in .the system, that which
ind that which cures disease. Neither of these actions are
;ic in the proper sense. The proper administration of a drug
ed upou the presence of a known morbid element in the sys-
his is not discoverable till constitutional derangement is evi-

symptomatie phenomena. Jahr says, "When Belladonna is
le invasive period of scarlet fever, its virus is held in abey-
tically imprisoned in the system, and the external manifea-
; is suppressed till the drug is withheld and the eruption
) appear." Many others have confirmed this statement,
evidence it appears that its use, previous to the fully devel-
;ion, is suppressive, an injury, and thus its claimed prophylac-
tics act as a mask. For it is the appearance of the eruption
gn heralding it at the proper time that the physician anx-
its, and this solicitude does not abate until the exanthem has
ly appeared. The use of Belladonna as a remedial agent,
arlet fever, is not determined until its second elective point,
i reached. For when it is prescribed for its first elective
throat symptoms, it is not then certain that the condition is
s. The unhesitating disposition of physicians to prescribe
■s a prophylactic, rests very largely upon the prestige of
.n's recommendation. Yet if any of his learned disciples

suggest such a proposition for experimental purposes only,

Bureau of Clinical Medicine. 103

it would be rejected at sight. His use of it, in a single case, proved
successful, and he says, "I reason thus, a remedy that is capable of
quickly checking a disease at its onset, must be its best preventive."
This proposition was made, however, respecting the treatment of the
Sydenham type, which has been, and is now, of rare occurrence ; con*
sequently, it is not applicable in the present form of the disease. To
anticipate and attempt to arrest the approach of a specific disease, by
antagonizing its specific elements, is legitimate, in the spheres of
hygiene and sanitation, but to attempt to eradicate from the system
morbific forces whose presence is conjectural, is like directing an
agent against an unknown thing of unknown origin. The period
covering more than a half a century, during which Belladonna has
been used as a prophylactic in scarlet fever, would seem to afford ample
time to determine its exact value. We ought to know our weakness
as well as our strength, and to attain this consistent position, gather all
available facts that there may be less diversity of opinion in the inter-
pretation of sequences. An analysis of my own cases in the last decade
leads me to conclude that physicians have used the term prophylactic
with too little consideration, and unwarrantedly have pursued this
method of using this drug.

Infection. — The nature and source of the infection of scarlet fever,
and its spread, have been the subject of much discussion. Many and
varied have been the theories presented to the medical world, but still
it is in a sea of doubt concerning them. Investigation in the line of
the germ theory has evolved nothing to demonstrate the existence of a
specific germ as a casual factor, nor is the propagation of this disease
by systemic susceptibility to any discoverable vegetable organism,
accepted. It is commonly cited, and perhaps largely endorsed, that
desquamating epithelial scales are vested with more infecting property
than any invisible agents. Desquamation is a common product of exan-
thematous diseases, and not a process peculiar to scarlet fever. It is a
result of intense capillary conjestion, hypernutrition being followed by
a diminution of nutrition below a normal point, when the epidermis is
thrown off as dead material. The disclosures of the microscope, cited in
the latest literature at my command, reveal neither germs nor any liv-
ing organisms upon the exfoliated scales. What are found upon their
surfaces are little hypenemic spots, which are not especial deposits of
the poison. Recent tests have demonstrated that the scarlatinous exu-
dations exhibit no effect upon animals by inocculation, and those organ-
isms present in the secretions and excretions are accidental or a result
of the disease, having no casual relation in its propagation.

104 Bureau of Clinical Medicine.

The proposition by the methods cited rests then upon an assumption,
which has gained credence by its age, and by the fact that from lack of
interest it has remained unchallenged by any great association of men
until recently. In addition to this information, 1 am convinced from
the scrutiny I have given this subject that the exfoliated epidermis is
not a common carrier of scarlatinous poison, and consequently not an
element of contagion. The small practical results from diverse views
regarding the pathological condition, and the sequences, strongly sug-
gest that the explorations in this field of medical knowledge have been
without proper chart or compass. Since the decision by scientific inves-
tigation, obtained with much difficulty, is after all uncertain, may we
not with better results turn our attention to observations and tests
which are analytical, detailed and recorded ?

Illustrative of these views, I cite a few recent cases, as more accurate
and detailed information can be obtained from those which are fresh in
memory. The first case was sporadic, the sanitary conditions were the
most unfavorable of any I shall present. The child was delicate, of a
well-to-do and intelligent family, who used every precaution for the
boy's health. The location was low, and probably damp ; near a brook
which answered the purpose of a sewer. No other children in the
families of the block or vicinitv were affected. This case was not
unusually severe, except otitis as the sequel. As soon as the case was
diagnosed the house was fumigated and disinfected for two weeks, and
the remaining child in the family was quarantined in the lower part of
the house and given Belladonna thrice daily. Four weeks after, the
quarantined child was attacked with the disease ; case mild, not
confined to bed, slight eruption, had otitis ; both cases desquamated.
The next case occurred on the opposite side of the city ; sporadic also ;
high altitude and good sanitary conditions. Was a typical case, otitis
followed ; no evidence of a possible exposure to infection. The father
and daughter were quarantined and took Belladonna three times daily,
the father having had scarlet fever thought it unnecessary and soon
discontinued its use. About ten days after the child's sickness, the
father was attacked. Had some difficulty in diagnosing the case ; had
inflammation of throat, without characteristic appearance of scarlet
fever ; it resembled follicular tonsilitis, had a scanty papular eruption
on the abdomen and back of the hands, persistent nausea and frequent
vomiting, diarrhoea and great prostration, followed by desquamation,
and a lingering convalescence. Twelve days after the father's attack
the daughter was taken sick with what simulated gastric fever ; throat
slightly congested, persistent vomiting, intense thirst, no eruption,

Bureau of Clinical Medicine. 105

temperature 103 degrees, great prostration, desquamated, gained
strength slowly. During the attendance on these cases, I was
called to a case of confinement in the lower tenement. The
children in the family had taken Belladonna since the first case in
the upper tenement ; no one of the family had the disease ; my visits
to the families treated were made without precaution against infection,
including the case of confinement. The next four cases were not under
my care, but being in an adjoining house I had them under observa-
tion. The first case in this family occurred two weeks after the first
one in the last mentioned family. Care was taken in this latter
instance, by isolation and ventilation, to prevent exposure to infection,
and Belladonna was taken by all, except the first case, which was a
typical one. Fourteen days after the first attack, three other children
fell sick ; two of these cases were mild, the other severe, with
glandular swelling as a sequel, with a slow recovery, all desquamated.
The possibility of infection occurring in the first cases was eliminated,
as was shown in each instance by every evidence which analysis affords.
If the idea of infection is admitted, each family was exposed by the
first case that occurred in it.

The instance when infection should have been most imminent and
disastrous was the parturient woman's. This fall (1886) have had three
mild cases in a family. Children living in another tenement of the
same house were purposely exposed, the mother desiring them to
contract the disease while it assumed such a mild form. A month has
now elapsed, and they have been, and still are, in their usual health.
This kind of evidence produces conviction. These cases alone prove
but little, but they, and numerous others more pronounced, current in
medical publications, are important as showing by their development
marked variance to the popular ideas regarding the illimitation of the
infection and incubation of scarlet fever. This fact, taken with the
failure of Belladonna to afford the protection claimed, confirm my
experience during the last decade, that the view held by those
professing such positiveness in these regards are unfortunate, if not
insupportable.

The attempt to sustain a theory of alarmingly immediate, or an
indefinitely postponed infection, corresponding to the emergency of
the case, or the whim of the physician, in the absence of conclusive
evidence, does not show a comprehensive conception of the disease.
The procession of facts that may be presented by painstaking observa-
tion, and analysis of cases, will prove the exceptions to the conventional
idea of infection to be too frequent and too pronounced to prove the

-1

Bureau of Clinicai, Medicine.

will be sufficient to disprove it. In summing up the
idea on this subject, very many inquiries press for an
t they are too numerous to consider here. I have no hesita-
iserting my conviction that the statements made, and the
;atliered, favoring the preventive power of Belladonna in
- er, and the methods of infection in this disease, are fatally
jy reason of the incomplete analysis of experience upon
claims are based, also that the deductions drawn from them
■ficial thought, or a manifest bias. The testimony of physi-
erning the cause of scarlet fever, is that it is unknown, and
3 spread, development, and complications, the unexpected
ays happens ; that the wealthy classes are not exempt from
, neither does altitude or sanitary excellence prove a barrier
■ess, and ecu versely, that filth, bad sewerage, squalor, defective
id poverty are not essential factors in its propagation, that
numberless causes of immunity from it, despite prevailing
ifection, and that the use of Belladonna causes no barrier to
38. Problems are presented in all this testimony which
tention. Only a decision based on an intelligent and adequate
them can dispel the skepticism of physicians, and give to
an intelligent and rational view of the subject.

DISCUSSION.

I. Gorham : In my experience there has been very little
ver in this city for the past eight years (except isolated
h every city lias I think), with the exception of last fall.
le there were about fifty cases in the western part of the
jstigation showed that the probable cause was due to drink-
ter obtained from wells in that locality. Xow I submit that
:rs of the Hudson are as contaminated as we are led to
m the statements in the paper, if there would not be a great
typhoid fever in this city than we have at present.

rluxTiso : There are reasons for believing that many cases of
ver are passed off as pneumonia, peritonitis and other forms of
dy experience is, that previous to using river water I was
led to treat a caae of typhoid fever, but since beginning its
re that I have had none to treat.

Bureau of Clinical Medicine. 107

Dr. Henry C. Houghton: It has been a surprise to me to see
many of our school expressing disbelief in certain apparent truths just
at the time when writers of the old school are putting forth these
beliefs. My first experience in the practice of homoeopathy was
under the supervision of Dr. Joslyn, Jr.; coming out from old school
experience in college and hospital, I was delighted in seeing these very
same things, for I had never seen them before. It was his practice to
give Belladonna to every person in a family where there was a
case of scarlet fever. While serving under him at the Five Points
House of Industry, I saw marked results from this treatment. The
" day children," those coming and going every day, always received a
dose of the Belladonna each day, whenever a case of scarlet fever
appeared among the children. We had in one year over one thousand
cases of children's diseases under our care and I only saw a few cases
of this disease among them.

Dr. M. S. Purdy : I would like to see this question of drinking
water discussed more thoroughly. It is said by some that a well will
drain an area equal to its depth. Is this true '( If so, we ought to
know it.

Some say that water is purified by passing through three feet of
earth, while others say that notwithstanding the fact that it has passed
through several feet of earth, the germs which produce disease are
still present.

Again, though chemistry may show the absence of inorgknic ele-
ments, organic materials may be present in sufficient quantity to pro-
duce disease.

It seems to me that the medical profession ought to take more inter-
est in this thing, and be more competent to instruct the people as to
its importance.

Dr. W. C. Latimer: People living in the country and in our
smaller villages, ofttimes have an erroneous idea concerning the loca-
tion of wells. They seem to think that if the well is placed on the
upper side of the house or barn, there is no danger of contamination,
taking it for granted that if the drainage is down hill on the surface,
it must be the same below the surface. I remember about twelve
years ago speaking to a physician in the western part of the State, that
a certain well ought to be filled up, as it had become unfit for use, I
thought. He replied that it was his opinion that the longer a well
was used the better it became. It has since been shown that the water-
shed underneath the ground was directly opposite to what it was on

'♦--r

ST/.

X . -

tit

108 Bureau of Clinical Medicine.

the surface. This was discovered in boring for oil. As soon as this
fact was known, water works were put in, and after that fevers pre-
vailed to a much less degree in that place than formerly. Now I think
if this subject was more thoroughly understood, and we were sure of
the direction of the watershed, many of these troubles could be
obviated.

Dr. T. L. Brown : Standing water is more dangerous, than run-
ning water. Many cases of scarlet fever, and other forms of disease,
are caused by standing water or wells. Water, like many other things,
is improved by motion ; the air itself is purified by falling rains. The
boiling of water destroys many deleterious effects. I think the purer
we can make our water the sooner we will cure our patients.

Dr. J. L. Moffat : I think that one of the most important
duties which the profession has to do, is to keep watch of all public
works, especially the water supply of our cities and villages, as well as
the matter of wells and plumbing in our own localities. We ought to
have an influence in the community and exercise it over proposed
public plans, no matter what. I was very much interested, when visiting
Shanghai, in their water works. They have a system of double cis-
terns. The water when taken from the river is thrown into a large
receiving reservoir, where it is allowed to settle, and from there
pumped into another reservoir, the process being repeated two or three
times. This may be a little crude, but it is a practical step in the right
direction, and one in which many of the systems in this country fail.

REPORT

OF THE

BUREAU OF OPHTHALMOLOGY.

Chas. F. Sterling, M. D., Chairman, - Detroit, Mich.

Drs. George S. Norton, New York.

F. Park Lewis, Buffalo.

N. L. McBride, - -.--. New York.

A. G. Warner, New York.

A CASE OF ENCYSTED FOREIGN BODY OF THE

IRIS.

By A. B. Norton, M. D.,

NEW YORK.

Frank D , pet. 15 years, Bristol, Conn., was 6ent to me at the

New York Ophthalmic Hospital, on Sept. 7th, 1886, with a history of
having been struck in the eye with a peach stone some two weeks
previous.

He had received no special treatment, having only seen his physician
the day before, who immediately referred him to me. Upon examina-
tion I found the eye very red, from both conjunctival and scleral
injection.

The iris was swollen, discolored, and adhered to the lens capsule ;
pupil was contracted. There was a small amount of pus in the anterior
chamber, and at the pupillary edge of iris ; extending outwards from
the pupil was a small yellowish-white spot, a little larger than the head
of a pin, which looked like a drop of pus resting on the iris. He had
had no pain in the eye from the first, and the cornea showed no

Bukeau of Ophthalmology.

of having been wounded. The case at this time was diag-
, as traumatic iritis. The patient was taken into the hospital,

pad applied to the eye. Atropine used every hour, and

he was given Hepar.

first ten days lie was in the hospital (contrary to all expecta-
made no material improvement ; the hypopion cleared up, but
^s and the spot upon the iris increased a little. Then (while
r the same treatment) the yellowish mass began to decrease,
ew days had almost entirely gone, while the redness of the eye
ttle noticeable.

d. About one week ago the improvement ceased, and the eye
etrograde and the cyst began to increase again. At present it
le size of a split pea, reaching from the pupillary border to

periphery of the iris, and is so prominent as to lay in contact
:ornea.

th. Various remedies and applications have been used with
; there is no change in the appearance of the mass since last
e cornea has become a little hazy, and blood-vessels are seen

from the outer border of the cornea to the point of contact of
it!) the cornea. Under tlte influence of Cocaine I made an
rough the cornea, at its outer side, about two lines from its

and with the iris forceps grasped the tumor (which was
avails breaking, and the contents became diffused over the
hamber, acting as though encysted. At this time found no

h. Eye healed quickly after the operation of the 24th, but
soon refilled and assumed the same shape and appearance as
Vday I again made an incision through the cornea with an
' knife,passing the knife directly through the center of the mass,
awing the knife blood and cystic fluid poured out. I then

hard rubber scoop and removed from the mass a foreign
!y the size of a pin's head, which proved to be a small piece

stone, evidently the fine point at the end of the stone. After
il of the foreign body the eye began to grow rapidly better,

patient was soon discharged from the hospital.
1. His physician wrote me to-day (in reply to my letter of
lat there was then scarcely any redness of the eye-ball, the
, clearing up, and some vision was returning.
» ; This case is reported not as having brought any glory
hysician (or I might say physicians, for he was seen at
iines by every member of the staff of the Ophthalmic

Bureau of Ophthalmology. Ill

Hospital), but rather as a warning in future cases. The fact of a
foreign body being in the eye was often discussed, but as pften discarded,
because from the nature of his injury (being struck with a peach pit),
could not believe that any portion of it had penetrated the eye ;
further, the cornea showed not the slightest abrasion from the first, and
nothing could be seen in the iris.

Foreign bodies in the iris are apt to cause cystic tumors by a doubling
up, or a folding over of the iris upon itself, with a retention of aqueous
humor secreted by the iris, and a gradual distension of this fold. They
have a tendency to increase in size, endanger the eye, and even threaten
the other eye through sympathetic irritation. Foreign bo'dies have
become encysted in the iris without causing any irritation of the eye,
but this is so extremely rare that we are not justified in allowing them
to remain. The treatment should be to remove the foreign body at
once, and I believe in this case of mine, if the foreign body had been
recognized and removed when he first came under my care, that the
results as to vision, etc., would have been more favorable, but it was
with me, as with one of the older surgeons, who remarked that no
similar case had ever fallen under his observation, and although the
final results demonstrated that the eye should have been opened earlier,
at the time the indications did not point to any operative procedure.

112 IjLKeau of Ophthalmology

A RARE CASE OF MORBUS BASEDOWIL

By F. Park Lewis, M. D.,

BUFFALO, x. y.

The following case is reported because, as far as the writer is aware,
it is unique in the history of Basedow's disease, and he desires, there-
fore, that it be placed on record :

The patient, a woman of nervous sanguine temperament and slight
build, had been married for five years. She was twenty-six years of
age. Had been in good physical condition until %he birth of her
child, one year after her marriage. Nothing of unusual interest had
occurred during her pregnancy, but her labor was protracted and
severe, and was followed by delirium lasting for several days after her
delivery. During the three months following she suffered more or
less constantly from metrorrhagia. Since that time she had never been
well. She had been rather more nervous than usual, when, three
years ago, it had become evident to her that her heart was beating
more rapidly and with more forcible impulses than was normal. This
continued without intermission, and in August, 1885, her left eye
began to protrude until, in a few days, it had become alarmingly
prominent. This proptosis had been accompanied and^was followed
by intense pain in the left temple and left eyeball,' exacerbations
occurring at irregular intervals, usually about a week apart, there
being meanwhile a more or less constant dull aching in the eyeball
and temple. Occasionally sharp neuralgic pains would dart through
the right eye and temple, but infrequently and with no regularity.
The more severe attacks were followed by general prostration.
Her dreams at night were horrible, quite frequently of falling from a
great height, and she would awake to find herself sobbing. She com-
plained of frequent sharp uterine pains, but an examination, made at
the writer's request by Dr/T. 6. Martin — who was then attending
physician at the Homoeopathic Hospital where she was being treated,
disclosed no abnormality. Her menstrual periods were regular. No
organic lesion of the heart could be discovered. Her pulse at the date
of her first visit was 98. The proptosis, she had noticed, was always

Bubeau of Ophthalmology. 113

increased by anxiety or nervous excitement. The heart beats at such
times were also more rapid and forcible. Frequently, before the eye began
to protrude, she had attacks of congestion of the head, with dizziness, fol-
lowed by blowing dark blood from the left nostril. She had frequently
been short of breath, and had been troubled with hot flushes followed
by chills. For the three months preceding her first visit to the writer,
together with the pain in the left eye and temple had been a severe
pain, in the morning on rising, in the neck and back of the head.
With the pain in the head had been a beating in the ear on the side of
the pain, sometimes on one side and sometimes on the other. Before
the protrusion of the eye, beating was felt in the orbit synchronous
with the pulse. Digestion was good ; her habit constipated. She
complained of a constant feeling of hunger not relieved by eating.
Her appetite had been moderate. A careful examination of the eye
discovered no organic change other than the unilateral proptosis.
Pupils normal in size and responding readily to light and accommoda-
tion. Media clear, retinal and optic nerves normal. No pulsation
discoverable in the retinal vessels.

The direct history of this condition was one of domestic infelicity
with actual physical suffering. During her post-partum illness she had
been deprived of necessities of life, and had suffered from exposure to
intense cold. She had been continuously in a state of nervous excite-
ment which was kept under repression, the tension being thereby
greatly increased.

Hare cases are reported of monocular exophthalmia in morbus
Basedowii, but none, as far as the writer is aware, have been published,
in which, with unilateral proptosis, the thyroid enlargement has been
absent.

Incidentally it may be remarked that the curative remedy was Nux
moschata, a drug which bears in many respects a close analogy to
the disease, and which has subsequently, in an incurable case with
enlargement of the heart, proven of great value in controlling many
of the nervous symptoms.

REPORT

OF THE

BUREAU OF LARYNGOLOGY.

Dillow, M. D., Chairman, - - New York City.

L Bull, Buffalo.

1. Jones, ' Albany.

pin, Brooklyn.

. Shklton, .... New York.

J* Leal, New York.

ohlkt, New York.

sue Remedies in the Treatment of
hseases of the air passages.

By L. A. Boll, M. D.,

BUFFALO, N. T.

ago, in this place, Dr. Houghton read a paper on the
sane Remedies, giving the results of his experience and
others investigate and report. His presentation of the
tly interested me, and caused me to study these remedies
ects, with the result that for the past nine months I have
y anything else. My paper will be in the nature of a
; remedies, and what I have been able to do with each,

Phos. I frequently begin the treatment of chronic
mditions of the air passages with Cal. phos. I find
quite a decided tonic action and influences the con-
; membranes for good ; in many cases it quite takes the
Cinchona preparations. In the headaches of children and
[ rarely need anything else. In the coughs of consumption

Bureau of Laryngology. 115

(chronic), and in the general condition presented in incipient phthisis
it does good work. Scrofulous enlargement of the cervical glands
frequently yields rapidly to its use.

Galcarea Sulph. This remedy I have used only in its catarrhal
sphere, i. e. where the secretions are thick, yellow, opaque and fre-
quently tinged with blood. Here it acts nicely, quickly clearing up
the condition of the mucus glands. One case of bronchitis, in the
stage of resolution, was very favorably acted upon by it.

Calcerea Fluoride. I have prescribed C. f . in but two cases, which
I will let speak for themselves.

Case I. An injury to the tibia of some years standing ; the growth
which came on the seat of this was very painful and had been
diagnosticated as osteo-sarcoma by a prominent surgeon, who advised
operation. When she came into my hands, some time after, I gave her
Cal. fluor., which relieved the pain, and, my latest report, is reducing
the growth.

Case II. A man with symptoms of secondary and tertiary syphilis
presented himself, showing the inferior turbinated bone and part of
the vomer from the right side which he had discharged through the
mouth. The odor from the nostril was horrible and was not mitigated
in the least by various sprays and the internal administration of Merc,
and Iod. pot. Finally he was put upon Cal. fluor., and a spray of
H 8 2 used once a day to thoroughly clean out the nostril ; from this
time he began to improve; the sanious discharge ceased, being
replaced by frequent effusions of blood, showing that granulation was
taking place, and the rapid relief from the odor was proof that the
dead bohe was being covered by a healthy structure or had been
cast off.

Ferrum Phos. This remedy disappointed me at first, but famil-
iarity with its action raises it higher (daily) in my estimation.
With me it takes the place of Aconite, and witfi this addition that it is
good in localized (inflammation) as well as general. I have used it in
some terrible cases of pulmonary congestion, and it carried them
through without any other remedy being required. With it I have
cured the sore throats of singers while they were using the voice daily.
I have had to thank Dr. Houghton for the hint given in his paper of
last year for singers to dissolve a tablet on the tongue just before
singing. Ferrum phos. has stopped a tendency to frequent nosebleed
in rapidly growing children.

Bureau of Laryngology.

*. In the treatment of throat troubles I now give K. m.
nerly gave the Mercuriee. I have had no occasion
iphtheria, but in sub-acute inflammation of the air passages
; ailed me, when given according to its indications. I give
ases having white coated tongue, superficial abrasions of
hiek tenacious secretions of either opaque, white, or of
:en. I find it about my best remedy in those cases where
it forms in the vault of the pharynx. In a case of this
was gratifying to see the eyes were cured of a chronic
j this remedy, given to relieve the nasal symptoms.
». This helped very materially a gentleman who, suffer-
ihronic pharyngitis, had a most fetid perspiration under
I have seen it benefit jn sleeplessness due to business

old catarrhal subject who came down with sciatica of a
type rapidly recovered under Kali phos. and suitable diet.
•h. My use of this remedy has been confined to

the typical yellow slimy secretion ; in a few cases it has
. I have also used it in cases of running ears when the
s thin, of bad odor, and yellow in color.
■» Phos. One of the most troublesome class of cases
had to treat has been that -of chronic pharyngitis with
)ugh. These cases come firmly believing tliat they
ption, or some chronic lung trouble nearly as had. They
le spasmodic cough which they usually refer to the pit of
d of course the lungs are sore from the strain of coughing.
s Mag. phos. will often surprise one by the quick relief it
[n other cases of chronic pharyngitis, with thickening of
of the pharynx, there is often choking on attempting to

swallowing a larger bolus than usual. In this class Mag. .
'es great relief.

Wur, One ease of nasal catarrh which I was treating
told me that it caused a very manifest reduction in
hydrocele, with which he had been troubled for years and
ien frequently tapped. In catarrhs where there is a thin
irge, worse on going into the cold and on exertion, N. m.

Phos. This remedy I have used but twice, and then as
;nt when gastric symptoms, acid risings, etc., came on.
n the indication of the yellow coat at base of the tongue
f.

Xairum StlpA. Use of this remedy has also been confined to pre-
scribing for intestinal tro-ibles, occurring in ease* under my charge,
for catarrhal complaints Bat in dispei*sary practice I hare seen two
cases of photophobia in sero talons ophthalmia resist almost every-
thing else and be relieved bv X. Sw

Silicea- The best results obtained by me during the past year have
come from Silicea. Several were in cases of chronic pharyngitis* com-
plicated with constipation, in one case of twenty five, another twenty
years, and a third still longer standing, these cases were cured with
Silicea. The first case dates back to a traumatic paralysis from the
waist down. The paralysis passed off but left constipation. Another
case, a man. a hay fever subject* spoke to me early in the spring about
his feet, they were so insufferably tender. A prescription of Silicea
cured him of this distressing feature, and when his hay fever time
came I gave him the same remedy with the gratifying result of almost
entirely relieving him. He had, after severe exposure, some running
of the nose, and on the hottest day of the summer some sneezing and
burning, otherwise he was able to attend to his business and be exposed
as never before.

In conclusion let me say that he who thinks that, because there are
but twelve remedies, he therebv finds things easv in the wav of cor-

. ~ at «

rect prescribing, is very much deluded, and 'will certainly find it out
very shortly after beginning such practice.

DISCUSSION

Dr. G. AL Dillow: I think that peroxyde of Hydrogen had
very likely much to do with the cure of one of the cases reported. It
would be difficult to say how much influence should be ascribed to the
Calcium fluoride and how much to the Hydrogen peroxide.

How do you differentiate between the remedies I Do you follow
the indications as given by Schussler, or by the appearance of the
parts as learned by experience ? I do not think we have a homoeo-
pathic remedy unless it has been so shown by the provings of healthy
persons. Some of the Schussler remedies have been proven, but not
11. A good deal of light is thrown upon their action by provings
ilready made. There is a good deal of empiricism in our school
o-day, which ranks as homoeopathy because small doses are used. We

#:-.cV-.S- •* •• r

•v

118 Bureau of Laryngology.

all ought to keep clearly in mind the distinction, that homoeopathy is
the application of drugs in accordance with the law of similars based
upon effects obtained by provings upon healthy persons.

Dr. L. A. Bull : In the treatment of my cases where I have a
pathological condition, such as a growth, et cetera, I use local reme-
dies, but where the trouble seems to arise from some dyscrasia, I use
only internal remedies. The cases reported were treated almost entirely
with internal remedies. »I use the fourth decimal trituration.
..* In reply to Dr. Dillow's question I will state that I have been guided
by both Schiissler's indications and my own experience. In beginning
to use these remedies I remembered a lecture by Prof. T. F. Allen, in
which he stated that the continued use of Iron or other proximate
principles of the body, would cause the loss of these principles in the
body. Taking this remark into consideration I thought that we could
use these remedies homoeopathically, knowing the tissues in which they
ore found and the diseases their absence causes.

REPORT

OP THE

BUREAU OF SURGERY.

Thos. D. Spencer, M. D., Chairman, - - - Rochester.

Drs. M. 0. Terry, Utica.

J. M. Lee, Rochester.

Geo. Allen, Waterville.

L. L. Brainard, Little Falls.

Newton M. Collins, - - - - - - Rochester.

With invited co-operation of Drs. H. C. Frost, Buffalo, and H. I.
Ostrom, New York.

Disputants : Drs. M. O. Terry and J. M. Lee.

AN OLD AUTHOR ON THE SYMPTOMS PRODUCED
BY SPINAL IRRITATION— HIS TREAT-
MENT-INCIDENTAL REMARKS.

By M. O. Terry, M. D.,

utica, n. y.

At the regular monthly meeting of the Homoeopathic Medical
Society of the State of New York, which was held in Albany during
the month of February, 1884, I read a paper which recited in brief
twelve cases of spinal and periosteal irritation, cured or greatly
benefitted by the instrument known as Paquelin's Thermo-Cautery.
Prefixed to this paper were quoted various authors, who had given this
subject great attention. No claim of originality will be entertained by
myself as to the treatment of these cases, but simply the credit of the
publication of the Jirst series of cases, thus drawing the attention of

BcRKAd OF SUEGBKV.

:ifession to a treatment which I consider superior to any
We say superior to any, for the reason that many cases,
them, had been under the care of physicians of
10 had used the various remedies and auxiliary treat-
ig the galvanic current, blisters, cupping and leeches,
^ere made from the writings of Hammond, Beard, Lilien-
Iramwell, Martin Kershaw, Sequiu, and H. B. Millard,
vriters. Having by a stroke of good fortune come into
>f quite an ancient work on this subject, I shall take the
ing from it the practical suggestions relative to the
urea of symptoms of spinal irritation. The work is that
ridgin Teale, and has for its title : " A Treatise of
ases Dependent upon Irritation of the Spinal Marrow,
: the Sympathetic." It was published in Philadelphia

includes within its range a great variety of diseases,
endless diversity, both in their symptoms and in the
:y are seated.

variety should exist ceases to excite surprise, when we
varied are the functions of the different nerves, and

the tissues and organs to which they are distributed.
entive observer of disease, neuralgic affections, under
inded signification, must repeatedly represent them-
skin, for instance, may be the seat of every degree of
linished sensibility, from the slightest uneasiness to the
ering, and from the most trivial diminution of sensi-
lete obliteration of feeling — symptoms not dependent
, affecting the different tissues of the part, but solely
norbid condition of the sentient nerves. The volun-
nay, in like manner, indicate, in a variety of ways, a
on of the nerves with which they are supplied. They
d with weakness, spasms, tremors, or a variety of other
es included within the two extremes of convulsions
The involuntary muscles may have the harmony of
iterrupted, from a morbid condition of their nerves;

be affected with palpitations; the vermicular motions
l, or the peristaltic action of the intestines, may be
gnlarity. The sensibility of the internal organs may
ected ; the heart, the stomach, the intestines being the
ferable to their nerves, and independent of inflammation,

Bureau of Surgery. 121

or any alteration of structure. The secretions may also undergo

alterations, both in quantity and quality, from a perverted agency

of the nerves upon which they depend.

********

" The difficulty and embarrassments which have attended the diag-
nosis and treatment of these affections, I am inclined to believe, has
principally arisen from mistaken views of its pathology. They have
too often been regarded as actual diseases of those nervous filaments
which are the immediate seat of the neuralgia, instead of being
considered as symptomatic of disease in the larger nervous masses
from which those filaments are derived ; hence, the treatment has too
frequently been ineffectually applied to the seat of neuralgia,
instead of being directed to the more remote, and less obvious seat
of the disease.

" There are many individuals in whom the complaint has existed, in
varying degrees of intensity, for a series of years, without its real
nature having been suspected ; the patients and their medical
attendants having regarded it throughout as a rheumatic or a nervous
affection. In this complaint, tenderness in the portion of the
vertebral column, which corresponds to the origin of the affected
nerves, is generally, in a striking and unequivocal manner, evinced
by pressure. In some instances the tenderness is so great that even
slight pressure can scarcely be borne, and will often cause pain to
strike from the spine to the seat of spasm, or neuralgia.

u The symptoms, of course, vary considerably, according to the
particular part of the spine which is affected, and bear reference to
the distribution of the different spinal nerves."

My principal object in making these quotations is to direct your
attention to the necessity of ever being on the alert for reflex symp-
toms. That physicians are frequently misled by them, my experience
has shown to be the case. Women are the more common victims, and
when they complain of frequent headaches, especially in the occipital
region, extending over the scalp, causing pains and disturbed vision ;
constant feeling of being tired, more particularly in the morning ;
rheumatic pains in various parts of the body, as between the shoulders,
in the lumbar or dorsal region, or in the chest, without a history of
pneumonia. If they have an occasional dry cough, it will be well to
run the fingers over the spinal vertabrse, using gentle pressure, to
ascertain if they are sensitive. It will readily be seen that a study of
the distribution of the spinal nerves will be of great value to assist in
tracing out these disagreeable, teasing, functional disturbances.

~* i .

*,*

&■■';■

a *;; .

122 • Bureau of Surgery.

|s N To show the results obtained by the author of the work published in

Lit' -i \^~\

|{;'.:}.* 1830, and to show also the fact that other methods than the thermor

||j > v cautery have given satisfaction, I will quote his words on that subject ;
fe*>'-: " Local depletion by leeches or cupping, and counter irritation

jj ;•';•;' ty blisters, to the affected portion of the spine, are the principal
|£v '. remedies. A great number of cases will frequently yield to the
single application of any of these means. Some cases, which have
even existed for several months, I have seen perfectly relieved by the
single application of a blister to the 6pine, although the local pains
have been ineffectually treated by a variety of remedies for a great
,length of time. A repetition of the local depletion and blistering is
however often necessary after the lapse of a few days, and sometimes
is required at intervals for a considerable length of time. In a few
very obstinate cases issues or setons have been thought necessary ;
and where the disease has been very unyielding, a mild mercurial
course has appeared beneficial.

" It is of course necessary that proper attention be paid to the regular
functions of the bowels, and to the treatment by appropriate means
of any other affection which may co-exist."

When there is a tendency to relapse, he uses a stimulating liniment
to the spine for a few weeks, composed of one part of spirit of
turpentine and two of olive oil.

The Treatment of the sac, in the Radical

Operation for Hernia.

By H. L Ostrom, M. D.,

NEW YORK.

The best method of dealing with the hernial sac, has been discussed
since the earliest attempt made by surgeons to preform an operation for
the radical cure of hernia, for with a knowledge of the anatomy of
the structures involved, the importance of the relation of the protrud-
ing peritoneum to the other parts of the rupture, could not fail to be
recognized. This subject, therefore, though one of great interest, and
one, the correct understanding of which must influence our percentage of
cures, has been worn thread-bare ; I think, however, that something
remains to be said, if only to emphasize the opinions with which you
may already be familiar.

Bureau of Surgery. 123

The minute anatomy of hernia, belongs to. and may be found in
any text-book of anatomy, this need not therefore detain us. The
points I here wish to illustrate, and which seem to me to be essential
to a clear understanding of the principles upon which the radical cure
of hernia must be conducted, are, first, the anatomical and physiologi-
cal peculiarities of the peritoneum ; and, second, the degree of strength
that the peritoneum affords to the naturally weak parts of the pelvis.

It is very evident that the peritoneal sac, when compared with the
muscular tissues through which a hernia protrudes, is of secondary
importance if the question is one of permanently closing the abdom-
inal opening, and restoring the continuity of the abdominal walls; but
I think it capable of demonstration, that regard to what may be
called the physiology of the hernial sac, will greatly aid to strengthen
the mechanically closed opening in the abdomen, and tend to seal
internally the newly formed line of union.

We will assume that the operation involves laying bare the hernial
6ac, and holding the borders of the opening in apposition, after they
have been rendered surgically capable of uniting. At this stage of
the operation we have lying between the vivified muscular fibers out
of which it is hoped to form cicatricial tissue, a blind tube composed of
serous membrane. The question therefore arises, shall we return this
intervening tissue into the abdomen, and direct our efforts towards
establishing immediate union between the muscular borders ? Or shall
we allow the peritoneum to occupy its abnormal position, and incor-
porate it in the inflammatory new formation that it is our design to
establish for the purpose of resisting visceral pressure ? Our answer
must be based upon both anatomical and clinical data.

The easy distensibility, and marked elasticity of the peritoneum, as
of all serous membranes, affords little reason to expect much of this
structure, in the way of guarding the hernial opening from a protru-
sion of the intestines. Simple restoration of the integrity of the peri-
toneum, can therefore exert no direct effect upon the permanent clos-
ure of the abdominal lesion, for the perfectly healthy membrane
requires only a slight force to push it forwards, but a peritoneal cicatrix
yields to even less pressure from within, as every laparotomist can
prove from his own experience. Now it is plain that these same qual-
ities of distensibility and elasticity that belong to the peritoneum gen-
erally, will not be lost when this membrane is incorporated in the cica-
tricial tissue that closes the abdominal opening ; and it is equally plain
from the position of the peritoneal cicatrix in the center of the new
tissue, that mechanically this structure will be the first to yield to

124 Bureau of Surgery

intra-abdominal pressure, and as a consequence, will favor a return of
the original visceral dislocation. If we could say that a serous mem-
brane is destroyed when held between two muscular surfaces that
are in a condition to unite by plastic exudation, the objection here
advanced to including the peritoneum in the sutures that bring the
opening together, would have little weight ; but I am not acquainted
with any experiments that prove the possibility of such a structural
metamorphosis. It is probable that a serous membrane always remains
such, and that when it forms a part of a reparative inflammation, it
does not lose its distinguishing features. Any operation, therefore, for
the radical cure of hernia will be anatomically incorrect, if the perito-
neal sac is allowed to remain between the pillars of the ring throngh
which t|ie intestine protrudes.

Though reference is here made especially to the management of the
sac in cutting operations, it will be found that clinically the best results
are obtained by the maneuveurs that invaginate the sac, and seek to
bring the margins of the opening, and the canal when one exists, in
direct contact. In Heaton's operation, the sac is at least temporarily
pushed into the canal ; and in Wiitzer's method, a very excellent pro-
cedure, when for any reason the more severe and extensive operation
is undesirable, a very essential feature is invaginating the peritoneum
upon the cylindrical instrument that aids in sitting up adhesive inflam-
mation. In Wood's operation, probable one of the most successful
that has been proposed for the radical cure of hernia, the fundus of
the sac is in vagina ted upon the finger before the needle is passed
through the ring, indeed one of the objects of this operation is to
return the peritoneal protrusion, and to retain it within the abdomen.
But these conservative methods have one common objection; they
more or less imperfectly return into the abdomen a certain extent of
peritoneum that has become greatly distended and relaxed while sur-
rounding the protruding viscera. Moreover, the use made of the sac
is at variance with what is known of its physiology, for it is designed
to make it a principal part of the cicatricial tissue. This portion of
peritoneum can neither in the abdomen, nor in the hernial canal, be of
any great service, and, therefore, it is better to amputate it as close as
possible to the external abdominal opening.

Since in 1826, when Lembert demonstrated in reference to suturing
the intestines, that serous surfaces brought in apposition unite rapidly,
many abdominal operations have been made possible that previously
were theoretical. Applying the French surgeon's discovery to
the treatment of the hernial sac, we find that it is only necessary to

Bureau of Surgery. 125

make the sac a closed canal, and to stitch it through and through, to
insure a good and firm union of its surfaces. But no additional
strength is gained by having this union extend the entire length of the
canal, therefore, and because it is desirable to bring the edges of the
opening in direct contact, the distal end of the sac should be removed.
Some operators prefer to tie the sac, and return it as a plug to the
abdomen, but such treatment does not appear to add to the success of
the operation, and it lacks the scientific accuracy, and the elegance,
that should belong to every surgical procedure.

The operation for the radical cure of hernia with which I have lat-
erally been most successful, combines several methods, especially those
of some English surgeons. It will be observed that my treatment of
the 8ac, with the exception of the method of obtaining union of its
surfaces, is the same as that adopted by Mr. Lucas, of Guy's Hospital.

After thoroughly exposing the whole length of the sac, so that an
opportunity is afforded to break up any external adhesions that may
exist, the contents of the sac is returned to the abdomen, and the neck
of the sac sewed with fine silk. The redundant sac, being virtually
strangulated, is then cut off, and the sewed, or proximal portion,
allowed to retract within the abdomen. After excising the ring with
Emmet 8 convex scissors, aided with a tenaculum, very much as we
operate on a lacerated convex — this I consider an essential feature of
the procedure — its edges are held together with rather fine silk, the
round, slightly curved needle being made to enter, and emerge, half
an inch from its free border. The sutures are sufficiently numerous
to hold the free edges in perfect contact, and are tied rather tightly,
their ends being cut short. A drainage tube is inserted, and the
external wound sutured with silk

In this operation an attempt is made to restore the natural relations
of the parts. The peritoneum is preserved as the continuous lining
of the abdomen, and the abdominal opening is simply closed, as before
the protrusion took place.

126 Bureau of Surgery.

A CONSIDERATION OF THE DIAGNOSIS AND

TREATMENT OF WOUNDS OF THE

FEMORAL ARTERY.

By L. L. Brainard, M. D.,

LITTLE FALLS, N. Y.

During the past year I was summoned to make a post-mortem
examination on the body of a man, who died from the effects of bullet
wounds through the upper third of each thigh. The primary cause of
death was not known until revealed by the examination, although the
case was attended by three physicians (all old school), one of whom
claimed considerable surgical experience. The man who fired the
shots is charged with murder, and will soon be tried ; one of the main
grounds of the defense will be malpractice in the treatment of the
wounds. It is for this reason that I make this case the subject of my
paper ; not that I expect to contribute anything ne\v*in the treatment
of gunshot wounds of arteries, but I deem the case, from the obscurity
of the symptoms, worthy of consideration by the physician as well as
the surgeon.

The man was shot while engaged in a melee in his own saloon ; he was
carried up stairs to his rooms ; complained of pain and numbness in the
left foot ; no hemorrhage to speak of. Upon examination two bullet
wounds were found, one in each thigh, near the apex of Scarpa's triangle.
The shots seemed to hare been fired from in front, and the missiles passed
out posteriorly, somewhat below a level with the point of entrance. On
account of there being no hemorrhage, and the existence of a counter-
opening in each thigh, showing that the bullets had passed out, nothing
was done but to apply compresses to each wound, bandage the thighs,
and ad vise perfect rest. But pain became so severe in the left leg
that a hypodermic injection of Morphia was given, and used more or
less until the end. The injury of the right thigh proved to be a simple
flesh wound, and it gave no trouble; cicatrization was nearly complete
when death occurred.

Bureau of Subgeby. 127

The left leg, however, became cold and senseless ; the toes looked
dark on the fifth day ; gangrene fully developed, and rapidly extended
to the body. When I saw him, on the eighth day, it involved the
scrotum, the gluteal and inguinal regions, as likewise the abdomen. He
died on the tenth day, of septicaemia.

The autopsy showed that the left femoral artery had been perforated
just below the profunda femoris, on its upper aspect ; also that the
vein had been opened and the nerve slightly cut There was a diffuse
traumatic aneurism, involving the muscles to the knee ; dark coagula
burrowed under the sartorius and infiltrated the quadratus femoris to a
large extent — all of which were in a decomposed state. Here was the
evident cause of death : Punctured wound of the femoral artery and
vein ; diffuse aneurism ; gangrene ; septicaemia.

Now, the question is, could this have been diagnosed soon after the
injury, and what should have been the treatment ?

To a practical and experienced surgeon, the question undoubtedly
seems simple and the answer easy ; but to us less favored ones, the
problem may be«worth of consideration, that we may be prepared for
similar emergencies. All the modern works on surgery lay down the
symptoms of wounds of arteries (punctured or incised) to be hemor-
rhage ; absence of pulsation in the distal extremity of the injured
vessel and coldness of the parts supplied by the same ; but the " key
note " is primary hemorrhage, and the one which calls for immediate
treatment. Without this we are somewhat in doubt, and need to wait,
or explore and find the extent of the injury. In this case there was
hardly any hemorrhage to be seen ; the tension of the thigh was
increased to some extent, but not marked ; the pulsation in the tibial
arteries was absent. This ought to have excited suspicion, yet one of
the best and most elaborate authorities on wounds of arteries with which
I am familiar, Lidell, {International Encyclopedia of Surgery), says —
and cites case to show — that a contusion of an artery from a bullet may
stop the pulsation in the distal extremity of the vessel, and be followed
by coldness, numbness, etc., and still result in recovery without any
treatment other than rest. Therefore we must wait and watch, and if
gangrene appear in the extremity, the diagnosis of injury of an artery
would be very certain.

The treatment in such cases requires the most careful consideration.
The surgeon, even of great experience, is often brought to the deepest
meditation as to what shall be the best course to pursue that " life and
limb" may be saved. On one hand the "vis medicatrix naturae"
must not be lost sight of, while on the other, the indications presented

Bureau of Surgebt.

et, and thus save the too often post mortem revelation and
" It might have been."

hemorrhage should be checked by immediate compression,
roximal and distitl ligatures applied as soon as possible. But
is like this, no external hemorrhage occurs. This is some-
;o moving the part immediately after the injury, which
muscular planes to slide past one another and compress the
essel.

condition the tissues are apt to be infiltrated, and the
s more of a question. The ligatures would not contribute
; limb, unless applied immediately; the tension from the
would prevent the collateral circulation from going on ;
; down upon and turning out the clots to any great extent
very doubtful procedure. It seems to me that the treatment
ondition would be to prepare well for sudden secondary
3, and wait ; and at the first appearance of gangrene,
be in the toes, amputate immediately above the injury, high
good healthy flaps, which in this case would have been at
it, or possibly just below the trochanters, either of which is
le operation, and attended by a high rate of mortality. But,
iding that, the duty of the surgeon would be done, and no
eglect would rest upon his shoulders; the cause of death
placed where it belongs, to the assailant. I am indeed
;at this neglect to amputate at the proper time is not
homoeopathic snrgery ; for if it were, the old cry, which
n even mentioned in the last decade, that " Homoeopaths
■r children, but they are no surgeons," would be resurrected,
icularly, would have to submit to the taunts of the so-called
' the old school, to the end of their desires. So if any one
ety shall be given an incentive, by the history of this case,
*r prepared for dealing with similar cases, it will be the
my anticipations for this paper.

/ '

sen

BUREAU OF SURGERY. 129

OVARIOTOMY (CLINICAL).

By J. M. Lee, M. D.,

ROCHESTER, N. Y.

Case I. Mrs. J. T., widow, aged 62 years, resident of Seneca
county, and mother of two children. Abdominal section, Dec. 4tli^

1884, and a thirty-six-pound unilocular ovarian cyst, four years grow-
ing, was removed. A single silk ligature was placed about the thick
pedicle, which was cauterized, and left inside. The abdomen was
closed with silver wire and Calendula dressing applied. Uninterrupted
recovery ; highest temperature, 100. Returned home the fifth week.

Case II. Mrs. P. P., married ; aged 61 years ; resident of Steuben
county, and mother of five children. She had been well, up to
within five years previous to coming under my observation in April,.

1885. During this time she had consulted many physicians and
patronized not a few infirmaries and u cure-all " establishments. The
various forms of baths and prescriptions produced no beneficial
effects ; and she received as many discordant opinions of the cause
of her disease as she had medical attendants. One thought all her
sufferings came from " retroversion and ulceration." Another consid-
ered her a "hypochondriac," and that "by proper management she
might be restored to health without much medicine." This plan of
treatment included, however, the free use of anodynes r and she went
from bad to worse until her nervous system was completely broken
down, and, when she came under my care, she at times was thought
to be insane.

An examination revealed a multilocular cyst extending high up in
the abdomen, giving it a prominent and flattened appearance. On
May 4th, 1885, about a month from the time I first saw her, I per-
formed ovariotomy, removing an eighteen pound tumor. The pedicle
was secured with silk, cauterized and dropped back into the pelvic
cavity. The abdomen was closed with silver wire, and wound dressed
! with Calendula. The healing process was by the first intention with-

out fever worth noting, or bad symptoms of any kind except those

BUREAU OF Sr/RGEBT.

eable to withdrawal of her accustomed anodynes. These
'mptoms were exceedingly annoying and caused me incom-
re trouble than all the other treatment,
hed, cried, imagined she saw familiar forms or faces in her

she had abscess of the liver, or other equally dangerous
ns, and summoned her friends to the bedside to see her
ithin an astonishingly brief period. These scenes were not

yet her condition otherwise remained normal. By means
iate treatment she returned home the fifth week, cured, not
! tumor, but also of the opium habit resulting from the
treatment of the " scientific school,"

. Mrs. C. D. C, of Genesee county, aged 41 years ; eleven
ed, but never pregnant. Had noticed abdominal enlargement
ire. At the first consultation, about five months ago, the
as rather larger than ordinarily in pregnancy at term, evenly
nd fluctuating. Uterus normal. Diagnosis clearly indicated
*t, probably unilocular. Ten days later, assisted by Dr.
>f Batavia, her family physician, and others, I performed
, removing a tumor weighing thirty -nine pounds.
three inches long. No adhesions. Pedicle short, tied with
r cut away with scissors, wound cauterized with Paqnelin's
tery and pedicle dropped back. No fluid or blood escaped
xlomen. The wound in the parietes was closed with silk-
and no adhesive straps were applied between the stitches as
inen rags saturated with equal parte of Calendula, Glycerine,
iter were placed on the incision, with a pad of raw cotton
ied by a flannel binder.

k followed the operation worth noting, and Aconite was
e slept three hours during the afternoon, and at ten o'clock
sning she expressed herself as feeling very comfortably.
jmperature was 109J. She slept seven hours during the
it six o'clock the next morning the pulse was 80, tempera-
;spiration 24. From this time on the patient was practically
ver. The wound healed by the first intention, under the
ily dressing, with not as much disturbance as often arises
iinary cold.

Miss S. L., Rochester, unmarried, 35 years of age,
>ne year noticed abdominal enlargement. An ovarian
diagnosed and tapped by her attending physician. Nothing
i developed up to this time ; but soon after, the tumor

she suffered much pain. It was not of a sharp, lancinat-

BlJBEAU OF SlTBGEBY. 131

ing character ; there was no characteristic discoloration of the skin, or
any other symptom which especially indicated cancerous degeneration.
She had occasional chills and fever. At the time of the operation,
July, 1885, her pulse was 135 and temperature 102£. On careful
examination it was thought that there was suppuration of the cyst,
and that its prompt removal might possibly save the life of the patient-
An eminent allopathic surgeon who saw her two days before the ovari-
otomy concurred in this opinion. Her parents were not slow to under-
stand the significance of her condition, and were anxious to take the last
chance to save her. She was placed on the table in a moribund state,
and my experienced anaesthetic assistant thought more than once that
be would not be able to sustain life until the operation could be
completed.

On dividing the structures of the abdomen the knife came down
upon diseased adipose tissue, which indicated something more serious
than mere suppuration of the sack. I halted here a" moment and my
colleagues advised me to go forward with the operation, as it could
only shorten her life for a few hours at the most In another moment
we opened into an ascitic cavity, which discharged a bloody fluid, and,
towards the last, much pus. The thickened peritoneum was now
divided, and the tumor found adherent to the parietes. The adhesions
were broken up by the fingers or enucleated, and the cyst was tapped
and removed. The cancerous degeneration was wide spread in the
abdomen, and the pelvic cavity contained a quart or more of pus. The
wound was closed with wire, properly dressed, and the patient placed
in bed ; she died twenty-three hours after. We felt quite satisfied
that she did not die on the table.

Case V. Mrs. L. Q., of Rochester, aged 45 years ; multilocular
cyst, five years growing. During the last two years had been tapped five
times. The sack was eighteen months in filling the first time, but the
frequent use of the trocar during the last six months had exhausted her
strength and reduced her almost to a skeleton. Towards the last she was
confined to the bed and her sufferings were intensified by large bed
sores over the spinous processes of three of the dorsal vertebrae, also
over a portion of the sacrum. In this latter situation the bone was
bare. She had declared that she would die before she would submit
to an operation, but as her time grew rapidly near she changed her
mind, and said she would have the tumor removed even if there was
only one chance in an hundred to save her life. Her anguish was now
so great that she preferred death to life, and requested me to complete
the operation even though she died on the table.

..x

Bureau of Subgbby.

Last December, assisted by Drs. White, Bissell, C. R. Sumner and
H. M. Dayfoot, I performed ovariotomy while her pulse was 130, tem-
perature 103, bowels actually inflamed and sack of tumor undergoing
suppurative degeneration. The abdominal walls were only one-quarter
of an inch thick, and the tumor was adherent. The less firm adhesions
were divided by the fingers ; others were enucleated or tied in two places
and cut between the ligatures. The omentum was badly diseased ;
one-half of it was gathered up, tied with silk and removed. The
pedicle was secured by ligature and cautery and the abdomen was
rinsed with simple warm water until it came away clear ; the wound
was closed with silk, and the patient placed in bed. The next morn-
ing the temperature had fallen to 100 and she seemed much improved.
An abscess formed in the excised omentum and discharged through the
upper end of the nine inch wound, from which, five weeks later, I
extracted the piece of silk placed around the diseased omentum. She
recovered perfectly and remains well. The tumor weighed fifty-two
pounds, and Dr. White, who removed her from the table after the
operation, estimated that she would not weigh over sixty-five or sev-
enty pounds.

Strict homoeopathic prescribing was adhered to throughout, which*
with perfect cleanliness, and Calendula dressings, was relied upon.

It will be noticed that there are no symptoms in Case IV which
direct especial attention to cancerous degeneration. Indeed, it was
impossible to determine the pathological condition without the explor-
atory incision. This is also true of Case V ; although the recovery
of this patient was scarcely hoped for, ovariotomy proved successful
even at the eleventh hour.

The case with the cancerous degeneration cannot reasonably count
against the per cent, of recoveries.

TRANSACTIONS

jHomoeopatbic /T^efcical Society

State of New York

FOR THE YEAR 18

VOLUME XXII.

PAST II.

ROCHESTER, N. Y.
PUBLISHED BY THE SOCIETY.

Rochester Democrat and Chronicle Print.

H0M0E0PATHie FREDieAL $0eiETY

OF THE

STATE OF NEW YORK.

Proceedings of the Thirty- Sixth Semi- Annual Meeting, held at Lyric Hall,
New York City, on the 20th and 2xit of September, 1887.

The meeting was called to order by President, H. M. Paine, M. D.,
of Albany. Prayer was offered by Db. A. S. Ball, of New York.

Drs. A. B. Norton and T. M. Strong were appointed a Committee
on Credentials.

The Committee on Credentials subsequently reported the following
members, delegates and visitors present :

Drs. H. M. Paine, George E. Gorham, Albany, Albany Co. ;
S. J. Fulton, Norwich, Chenango Co. ; Buren, Bethany, Columbia
Co.; C. P. Cook, Hudson, Columbia Co.; P. A. Banker, Rhinebeck,
Duchess Co.; L. A. Bull, Buffalo, Erie Co.; Susan S. McKinney,
Samuel Talmage, Gertrude G. Bishop, Wm. E. McCune, John L.
Moffat, Everitt Hasbrouck, E. Chapin, Wm. M. Butler, H. D. Schenck,
Wm. C. Latimer, Alice B. Campbell, Alton G. Warner, E. J. Wall,
S. Catherine Martineau, H. O. Rockefeller, Max G. Hein, W. B.
Winchell, A. von der Liihe, R. C. Moffat, Brooklyn, Kings Co.; Robert
Boocock, Flatbush, Kings Co.; J. M. Lee, Herbert M. Dayfoot, Roch-
ester, Monroe Co. ; I. G. Baldwin, A. S. Ball, H. I. Ostrom, M. W.
Palmer, A. W. Palmer, J. W. Dowling, T. Franklin Smith, St. Clair
Smith, Henry M. Smith, Robert McMurray, W. H. King, Lewis Hal-
lock, J. M. Schley, George G. Shelton, C. W. Cornell, George M. Dil-
low, E. J. Pratt, Malcom Leal, Clarence E. Beebe, Chas. C. Boyle,
F. H. Boynton, Sidney F. Wilcox, Edwin West, F. M. Dearborn, S. H
Vehslage, A. Berghaus, N. A. Mossman, Walter H. Jones, George S.
Norton, John H. Thompson, A. B. Norton, D. B. Hunt, H. M. Dan.
forth, M. A. Brinkman, T. F. Allen, Egbert Guernsey, Henry C.
Houghton, Fred S. Fulton, A. M. Woodward, W. S. Miner, J. F. Land,

fit

^••'

4 Proceedings.

Louis A. Queen, Clarence C. Howard, Virgil Thompson, E. D. Frank-
lin, J. S. Cummins, F. M. Cummins, Chas. E. Teets, George W.
McDowell, Wm. H. Scott, H. Worthington Paige, Sarah N. Smith,
ii-'r. "W". S. Pearsall, B. J. Burnett, John J. Russell, J. B. Garrison, R. E.
Hinman, Arthur F. Eife, B. G. Carleton, G. T. Hawley, S. H. Knight,
E. Guernsey Rankin, C. Eurich, F. W. Hamlin, L. Lannin, Chas.
Deady, Amelia Bassett, New York, New York Co.; T. M. Strong^
W. N. Reynolds, C. E. Chase, W. T. Helmuth, Jr., Martin Deschere,
Chas. McDowell, F. H. Monroe, Wards Island, New York Co.; M. O.
Terry, Utica, Oneida Co.; Selden H. Talcott, Edwin Fancher, Middle-
town, J. W. Ostrom, Goshen, Orange Co.; C. A. Beldin, Jamaica,
Queens Co.; E. L. Crandall, E. S. Coburn, Troy, Rensselaer Co.;
M. W. Van Denburg, Fort Edward, Washington Co. ; G. D. Dresser,
Shrub Oak, E. P. Swift, Pleasantville, Westchester Co.; James
Hoffman, S. Wellman Clark, Jersey City, N. J.; C. W. Butler,
Montclair, N. J. ; Sarah C. Spottiswood, Orange, N. J. ; Harriet L.
Knudsen, Newark, N. J.; Sayer Hasbrouck, Providence, R. I.;
E. H. Linnell, Norwich, Conn.; F. B. Kellogg, New Haven, Conn.

Communications from Drs. Helmuth and Dowling were received
explaining their absence from the meeting. A communication from
Alfred K. Hills, M, D., Secretary of the Medical Board of the
Homoeopathic Hospital at Ward's Island, tendering every courtesy to
the Society and extending an invitation to visit the Island.

Dr. Strong was appointed a Committee to carry out the wishes of
the Society in accepting the invitation.

On motion, a Committee consisting of Drs. Lee, Houghton and Bull
was appointed to take suitable action regarding the Semi-Centennial
Meeting at Pittsburgh.

The Committe subsequently reported the following telegram, which
was adopted and ordered sent :

The Homoeopathic Medical Society of the State of New York ex-
presses fraternal sentiments and tenders its congratulatory greetings to
the Homoeopathic Medical Society of Pennsylvania on the occasion of
the fiftieth anniversary of the introduction of homoeopathy into the
city of Pittsburgh.

The President, Horace M. Paine, M. D., then delivered the follow-
ing address.

Gentlemen of the Society :

It becomes my pleasant task to announce that the hour has arrived
*or the beginning of the sessions to be held in connection with the

Thirty-Sixth Semi- Annual Meeting. 5

thirty-sixth Semi- Annual Convocation of this Society, and to declare
that the meeting is open for business.

In connection with the exercise of this official prerogative, I may be
permitted, briefly at least, to grapple with Father Time, and compel
him to retrace his hurried steps, in order that we may rescue from ob-
livion a few of the items of personal history which he, in his impetuous
forward career, is steadily endeavoring to cover with the cobwebs of
the ages.

I well remember attending the first meeting of this Society, and
some of the incidents connected therewith. The records state that :

"In accordance with previous notice, a number of homoeopathic
physicians, from different parts of the State of New York, assembled
in the Common Council room of the city hall, in the City of Albany,
at ten o'clock in the forenoon of May 15th, 1850, for the purpose of
devising such measures as the condition and interests of homoeopathy
in this State should render expedient."

I think there were about twenty physicians present. Prominent
among the names of these worthies are those of Drs. John F. Gray,
I. M. Ward, S. R. Kirby, Jacob Beakley, Henry D. Paine, E. D. Jones,
J. W. Metcalf, E. S. Byran, A. S. Ball and Alonzo Hall.

Of these, as far as I and able to ascertain, only five or six remain.
These are Drs I. M. Ward, H. D. Paine, E. D. Jones, A. S. Ball and
H. M. Paine.

At the first meeting, on proceeding to an election of officers, a spon-
taneous eruption of personal fellowship was strikingly brought out in the
election of Dr. I. M. Ward to the presidency. There had been no
previous canvassing. There were no apparent motives for the selec-
tion of one candidate in preference to another, other than the strength
of personal friendship.

Dr. Ward had resided in Albany seven years. A few months prior
to the meeting he had removed to New Jersey, and for that reason his
eligibility was questioned. He was almost unanimously elected, how-
ever, on the ground that it was his intention to spend two months each
summer at Saratoga.

Dr. Ward's election was unquestionably owing to his suavity, agree-
able manners, and an intimate personal acquaintance with all the mem-
bers who were present.

Dr. Kitby was the talker for the whole school. He could talk
against time on any subject connected with medicine that might be
brought up,. His great, un wieldly body; his portly bearing; his

J . f * V ' J j*i <•

!■* V

6 Proceedings.

astonishing mobility of countenance ; his peculiar lisp ; bis earnestness
of manner when interested in any subject under discussion, combined
Sf to constitute a character and person the like of whom has not since
been seen in our midst

Dr. J. F. Gray, it seems to me, ought to bave been honored by the
presidency. He had even then attained eminence in his profession.
His great learning ; his recognized skill as a diagnostician ; his frequent
contributions to the medical literature of the day, ought not, it would
seem, even at that early day, to have been overlooked. Twenty-one
years afterward, however, his profound erudition and great ability
were duly recognized by the Society by his election to the presidency,
the nineteenth on the list.

I became intimately acquainted with Dr. Gray during the latter years
of bis life, and learned to admire his good qualities and to have great
respect for his opinions and wishes regarding many of the practical
medical questions of the day.

Dr. Metcalf would, had he lived longer, have become one of the
shining lights in our school. He possessed a clear, logical mind. His
writings have enriched our materia medica. His quiet, reserved man-
ner, and his forcible and timely utterances, are still deeply impressed
on my memory.

Dr. Ball, whose flowing locks are whitened by more than four score
and eight winters, is still here with us. His venerable and stately form
has been seldom seen at the meetings of the Society. His life work
has been that of a faithful adherent to homoeopathic principles, and an
honest endeavor to apply them in the treatment of disease.

The last of these founders of the Society whose name I will mention
in these brief notes is that of the versatile Beakley.

I do not think that Professor Beakley was present at the first meet-
ing; he was, however, a frequent attendant at the sessions of the
Society subsequently. He always related interesting cases, and was
always a great stickler for a strict observance of parliamentary rules.

At the first meeting of the Society he was appointed chairman of a
committee to prepare an address to the homoeopathic physicians of the
State "urging united and harmonious action." Thus early, at the very
beginning of the organization, his tact and fostering services were made
instrumental in laying the foundation of permanence, development and
substantial progress, by which we, his survivors, have been profited,
and have richly enjoyed.

But how does it happen that at the very start, thirty-seven years

o, effort was needed to secure the desirable qualities represented by

Thibty-Sixth Semi Annual Meeting. 7

unity of sentiment and harmony of action ? One would suppose that,
having kindred purposes and interests, the homoeopathists, of whom at
that time there were about two hundred in the State, would instinct-
ively coalesce, and that no special effort for promoting unity and har-
mony would be required.

These essential qualities were needed at the inception of this organi-
zation, in order the better to maintain a defensive position against an
opposing school and system ; and from that time to the present the
reasons for putting forth effort with a view of promoting unity and
harmony among homoeopathists, have been just as cogent and forcible
as they ever were.

Organized opposition to homoeopathic truth, although of late years,
from motives of policy, is less pronounced, covertly is as earnest and
active as any time in the history of this Society.

What these reasons are ; why we allow ourselves to be recognized
by a distinctive name ; why we are continually planning to maintain
our distinct organizations, to develop our resources, and make more
rapid advances in future, I must make the subject of an address at the
next annual meeting. Suffice it for the present to say, that so long as
the dominant school refuses to accept the homoeopathic principle as
the leading one in the domain of therapeutics, and places us and our
school under a ban because we hold such a tenet, and so long as non-
homoeopathists refuse to teach their own students the benign truths of
homoeopathy, it is incumbent upon us to hold our position, to maintain
a separate organized existence, and above all to retain the distinctive
name; for, if we give up our name, who, and what, and where are we ?

The distinctive name is our birthright ; it is ours by inheritance ; it
is ours by conquest ; it is ours, and ever will be ours, in spite of our-
selves, so long as homoepathy is known as a recognized method of cure.

Gentlemen, the meeting is now open for the transaction of business.

The address was referred to a committee consisting of Dbs. A. B.
Nobton, Gobham and Dillow.

REPORT OF THE BUREAU OF MATERIA MEDICA.
(For paper and discussion see hv/reau report.)

The Pbesident called for the report of the Bureau of Materia
Medica, E. H. Wolcott, M. D., Chairman.

Db. Woloott being absent, Db. VanDenbubg presented the bureau
report.

8 Proceedings.

REPORT OF THE BUREAU OF LARYNGOLOGY.

L. A. Bull, M. D., Chairman. (For papers and discussions see
bureau report.)

The Society adjourned until 3 p. m.

AFTERNOON SESSION.

On motion the courtesy of the Society was extended to 0. W. But-
ler, M. D., President of the New Jersey State Homoeopathic Medical
Society; E. H. Linnell, M. D., President of Horn. Med. Society of
State of Connecticut, and all visiting physicians.

The following telegram was received and read :

Pittsburgh, Pa., Sept. 20, 1887.

To Dr. H. M. Dayfoot, Secfy New York State Horn. Med. Soc. :

The Homoeopathic Medical Society assembled at Pittsburgh send
greeting to the Homoeopathic Medical Society of the State of New
York.

(Signed), A. R. Thomas, M. D., President.

Clarence Butler, M. 1)., Secretary.

The committee on President's Address reported the following reso-
lution, which was adopted :

Resolved, That as long as the dominant school of medicine refuses
to accept the homoeopathic principle as the leading one in the domain
of therapeutics, and places homoeopathic physicians and the homoe-
opathic school under a ban ; and so long as non-homoeopathists ref ase
to teach their own students the benign truths of homoeopathy, it is
incumbent upon the homoeopathic school to hold its position, to main-
tain its separate organizations, and to retain its distinctive name.

The Committee on Medical Legislation reported the following :

Mr. President;

The Committee on Medical Legislation have the honor and pleasure
to report that the Bill, substantially as introduced last year, entitled "An
Act to regulate the licensing and registration of physicians and sur-
geons, and to codify the medical laws of the State of New York," has
become a law.

Thirty-Sixth Semi-Annual Meeting. 9

It had a perilous passage from the time it was introduced into the
Assembly early in the session, nntil it received the Governor's signa-
ture late in June. Irregular practitioners and some members of the
eclectic school assailed it with a surprising amount of ignorance and
oratory. Your committee appeared before the committee on public
health time after time during the winter, to show the merits of the
bill and listen to doctors, lawyers and laymen in their attempts to
defeat it.

The committee feel greatly indebted to Dr. Bendell, of Albany,
Chairman of the Committee of Medical Legislation for the Medical
Societv of the State of New York, for his able and efficient labors in
behalf of the Bill. To him and the attorney employed by his commit-
tee, Mr. Purrington, and our own indefatigable Dr. Paine, we are
indebted for the passage of the Bill ; and I would ask that the thanks
of this Society be tendered these gentlemen.

I herewith hand you a certified copy of the law.

Geo. E. Gobham, Jno. J. Mitchell,

H. M. Paine, Hebbert M. Dayfoot,

Lester M. Pratt, A. E. Wright,

Selden H. Talcott, E. M. Kellogg,

Everitt Hasbrouck, Edward S. Coburn,
Asa S. Couch, Committee.

LAWS OF NEW YORK.— By Authority.

[Every law, unless a different time shall be prescribed therein, shall com-
mence and take effect throughout the State, on and not before the twentieth
day after the day of its final passage, as certified by the Secretary of State.
Sec. 12, title 4, chap. 7, part 1, Revised Statutes.]

Chap. 647.

AN ACT to regulate the licensing and registration of physicians and

surgeons, and to codify the medical law6 of the State of New York.

Passed June 23, 1887 ; three fifths being present.

The People of the State of New York, represented in Senate and
Assemhlg, do enact as follows :

Section 1 . No person shall practice physic or surgery in this State
who shall not have attained the age of twenty-one years ; and no per-
son shall practice as aforesaid unless he or she shall be, at the time this
act shall take effect, a person lawfully engaged in such practice in this
State under license or authority conferred by its laws then in force, and
lawfully registered pursuant to chapter five hundred and thirteen of

10 .Proceedings.

the laws of eighteen hundred and eighty, and the acts amendatory
thereof, or unless he or she shall be licensed or authorized so to prac-
tice by the provisions of this act, and registered as herein prescribed.

§ 2. From and after the date of the taking effect of this act, no per-
son not theretofore licensed or authorized to practice physic or surgery
in this State shall be deemed so licensed or authorized except one of
the three following classes :

First. All who shall have been graduated from an incorporated med-
ical school or college in this State with the degree of doctor of medi-
cine, after substantial compliance with all the requirements of the
general laws and of the charter of said corporation regulating the term
and amount of study, attendance and attainment requisite to obtain
said degree ; provided that no person shall receive the degree of doctor
of medicine, or be licenced to practice physic or surgery in this State,
unless after the age of eighteen he shall have pursued the study of
medical science for at least three years in a chartered medicaj school
or with aome physician and surgeon duly authorized by law to practice
physic or surgery ; and shall have attended two complete courses of
lectures in some legally incorporated medical school or college, in good
standing at the time of such attendance, prior to the granting to him
or her a diploma or license ; provided, further, that two courses of lec-
tures, both of which shall be either begun or completed within the
same calendar year, shall not satisfy the above requirement.

Second. All who have received said degree from the Regents of the
University of the State of New York after substantial compliance with
the legal requisites preliminary to its attainment, and after examination
by a legally constituted board of medical examiners of this State.

Third. All who, having been graduated from incorporated medical
schools or colleges without the State as doctors of medicine, or licensed
to practice physic or surgery under the laws of those European coun-
tries in which said degree does not confer the right so to practice, shall
procure their diplomas from said corporations, or their licenses from
such countries, to be indorsed by the faculty of an incorporated medical
school or college within this State, or by the Regents of the University
on the recommendation of a legally constituted board of medical exam-
iners of this State. Every such indorsement shall be in form of sched-
ule A or of schedule B provided by the tenth section of this act. Every
corporation or board so indorsing, shall keep a record of their indorse-
ments, and may require applicants to verify their statements under
oath ; any indorsement made with fraudulent intent, or gross careless-

' * m

Thibty-Sixth Semi- Annual Meeting. 11

Hess or ignorance, shall be deemed a misdemeanor and shall subject
the indorser or indorsers, upon conviction thereof, to a fine of two
hundred and fifty dollars.

§ 3. Every person who, at the time this act shall take effect, shall be
practicing lawfully physic or surgery in this State, under the authority
and license conferred by the laws then in force, but who shall not be
then duly registered in the county where he or she practices ; and
every person who shall thereafter become lawfully authorized or licensed
to practice physic or surgery in this State, shall register in a bock to be
kept in the clerk's office of the county in which such practice is carried
on, his or her name, residence, place and date of birth, and authority
for practicing as aforesaid. Every person who shall apply to register
as a physician or surgeon shall be required, before registration, to sub-
scribe and verify by oath or affirmation, before a person qualified to ad-
minister oaths in this State, an affidavit which shall be filed and pre-
served in a bound volume. This affidavit shall be in the form prescribed
in schedule C, provided by the tenth section of this act. Every person
registering as aforesaid shall exhibit to the county clerk his or her
diploma or license, or in case of loss, a copy of either, legally certified as
are copies of documents admitted in evidence, or a duly attested tran-
script of the record of its conferment from the body conferring it, upon
which the said clerk shall indorse, or stamp his name, and the words
" Presented and registered as authority to practice physic and

surgery by , on the day of , in the clerk's office

of county." The said clerk shall also give to every registered

physician or surgeon a certificate in the form of schedule D, provided
by the tenth section of this act. For all of his said services the county
clerk shall receive as a total fee for registration, affidavit and certificate
the sum of one dollar. It is provided, however, that nothing in this
act shall require- any physician or 6urgeon who shall have duly regis-
tered lawful authority to practice as such, conformably to the provisions
of chapter five hundred and thirteen of the laws of eighteen hundred
and eighty, and the acts amendatory thereof, to register again under
the provisions of this act, in any county where he or she shall have
registered already.

§ 4. A practicing physician or surgeon having registered lawful
authority to practice physic or surgery in one county, who shall remove
his practice or part thereof to or regularly engage in practice or open
an office in another county, shall exhibit in person to the clerk of such
other county, or shall send to him through the mail by registered letter,

12 Proceedings.

his certificate of registration, and if such certificate shows lawful
authority to have been registered said clerk thereupon shall register
said applicant in said latter county, on receipt of a fee of twenty-five
cents. The clerk shall stamp or indorse upon such certificate the words
" Registered also in county," and return the same and every cer-

tificate and indorsement made pursuant to the provisions of this act
shall be prima facie evidence in any legal proceeding that the person
named has registered in the office issuing the same, the authority stated
in the transcript.

§ 5. Every person now licensed to practice physic or surgery in this
State under the laws thereof in force at the time of the conferment of
such license, unless he or she already shall have registered his or her
name, residence, place of birth and authority so to practice pursuant to
the provisions of section two of chapter five hundred and thirteen of
the laws ofc eighteen hundred and eighty, and the acts amendatory
thereof, shall comply with the requirements of said chapter on or be-
fore the first day of October, eighteen hundred and eighty-seven ; and
thereafter no person shall be entitled to register any authority to prac-
tice physic or surgery, except the license conferred under this act, and
the laws enacted hereafter, and no registration shall be considered
valid as such unless the authority registered constituted at the time of
registration a license under the laws of this State then in force; pro-
vided that nothing in this section shall be construed to prohibit or sus-
pend any prosecution for non-registration under said section instituted
prior to said first day of October, eighteen hundred and eighty-seven
and further provided, that no diploma or license conferred upon a
person not actually in attendance at the lectures, instruction and
examination of the corporation conferring the same, or not possessed at
the time of its conferment of the requirements then demanded of med-
ical students in this State as a condition of their becoming licensed so
to practice, shall be deemed lawful authority to practice physic and
surgery in this State.

§ 6. No person shall be licensed or permitted to practice physic or
surgery in this State who has been convicted of a felony by any court
of competent jurisdiction ; and if any person who is or hereafter shall
be duly licensed to practice physic or surgery in this State, shall be
convicted of a felony, as aforesaid, his or her license to so practice, if
any, shall be revoked by the fact of such conviction having been had.
Any person who shall willfully swear falsely to any statement con-
tained in any affidavit made pursuant to the provisions of this act shall

Thirty-Sixth Semi-Annual Meeting. 13

■

be deemed guilty of a felony, and subject to conviction and punish-
ment for perjury ; any person who falsely and without authority shall
counterfeit, make or alter any diploma, certificate or instrument con-
stituting a license to practice physic or surgery within this State, or
any certificate or indorsement given in pursuance of this act shall be
deemed guilty of a felony, and be subject to conviction and punishment
for forgery in the second degree ; any person who shall practice physic
or surgery under a false or assumed name, or who shall falesly person-
ate another practicioner of a like or different name, shall be deemed
guilty of a felony, and shall be subject to conviction and punishment
for false personation; and any person guilty of violating any of the
other provisions of this act, not otherwise specifically punished herein,
or who shall buy, sell or fraudulently obtain any medical diploma,
license, record or registration, or who shall aid or abet such buying,
selling pr fraudulently obtaining thereof, or who shall practice physic
or surgery in this State under cover of a diploma or license that shall
have been illegally obtained, or that shall have been signed or issued
unlawfully or under fraudulent representations, or mistake of fact in
material regard, or who, after conviction of a felony as aforesaid, shall
attempt to practice physic or surgery in this State, and any person
who shall assume the title of doctor of medicine, or append the letters
" M. D." to his or her name, without having received the degree of
doctor of medicine from some school, college or board empowered by
law to confer said degree or title, shall be deemed guilty of a misde-
meanor, and upon conviction thereof shall be punished by a fine of not
less than two hundred and fifty dollars, or imprisonment for six months
for the first offense, and upon conviction of a subsequent offense, by a
fine of not less than five hundred dollars or imprisonment for not less
than one year, or by both fine and imprisonment. Any person who,
not being then lawfully authorized to practice physic or surgery in this
State and so registered according to law, shall practice on or after the
first day of October, eighteen hundred and eighty-seven, physic or
surgery within this State without the license and registration provided
for in this act, shall be deemed guilty of a misdemeanor, and on con-
viction thereof shall be punished by a fine of not less than fifty dollars
for the first offense, and for each subsequent offense by a fine of not
less than one hundred dollars, or by imprisonment for not less than
one hundred days, or by both fine and imprisonment. When any
prosecution under this act is made on the complaint of a lawfully
incorporated medical society of this State, or a county society entitled
to representation in a State society or association, the fines when collected

14 Proceedings.

shall be paid to the society making the complaint, ^nd any excess of
the amount of fines so paid over the expense incurred by the said
society in enforcing the medical law of this State, shall be paid at the
end of the year to the county treasurer, for the use of the poor of said
county.

§ 7. The duly incorporated medical societies of any county in which
any person shall practice physic or surgery without lawful authority
or registration may, upon proof of such practice, recover from such
practitioner, in an action before any justice of the peace, a penalty of
twenty-five dollars and the cost of the action for the first judgment,
and upon every subsequent judgment for the same offense a penalty
of fifty dollars and the cost of the action ; provided that said societies
shall pay to the county treasurer for the use of the poor of said
county any surplus that may accrue in their hands from the excess of
fines and penalties collected over the disbursements of said society for
counsel fees and the expenses incident to the enforcement of this act
by them.

§ 8. Nothing in this act shall be construed to punish commissioned
medical officers serving in the army or navy of the United States, or in
the United States marine hospital service, while so commissioned, or any
one while actually serving as a member of the resident medical staff
of any legally incorporated hospital, or any legally qualified and reg-
istered dentist exclusively engaged in practicing the art of dentistry,
or interfere with manufacturers of artificial eyes, limbs or orthopedical
instruments or trusses of any kind from fitting such instruments on
persons in need thereof; or any lawfully qualified physicians and sur-
geons residing in other States or countries meeting registered physicians
and surgeons of this State in consultation, or any physician or surgeon
residing on the border of a neighboring State, and duly authorized
under the laws thereof to practice physic or surgery therein, whose
practice extends into the limits of this State ; providing that such prac-
titioner shall not open an office or appoint a place to meet patients or
receive calls within the limits of the State of New York ; or physicians
duly registered in one county of this State, called to attend isolated
cases in another county, but not residing or habitually practicing
therein.

§ 9. The following acts and parts of acts are hereby expressly
repealed, to wit : Sections eight to twenty-two inclusive of title seven
of chapter fourteen of part one of the Revised Statutes ; also all of
chapter one hundred and thirty-eight of the laws of eighteen hundred

Thirty-Sixth Semi-Annual Meeting. 15

and six, that provided for the examination and admission of medical
students to practice, and for penalties for practicing physic and sur-
gery without a diploma or other lawful authority ; also section or para-
graph fifth of chapter one hundred and four of the laws of eighteen
hundred and seven ; also sections nine, ten, eighteen and all of section
eleven following and including the words "whose duty" of chapter
ninety-four of the laws of eighteen hundred and thirteen ; also sections
one, two, four, and all of section three following and including the
words "any three" of chapter two hundred and six of the laws of
eighteen hundred and eighteen ; also section two of chapter two
hundred and thirty-seven of the laws of eighteen hundred and nineteen ;
also chapter one hundred and twenty -six of the laws of eighteen hun-
dred and thirty; also sections one, two and four of chapter five hun-
dred and thirty-two of the laws of eighteen hundred and thirty-six;
also chapter sixty-four of the laws of eighteen hundred and forty -one ;
also chapter two-hundred and seventy-five of the laws of eighteen hun-
dred and forty-four ; also chapter four hundred and thirty-six of the
laws of eighteen hundred and seventy-four ; also chapter five hundred
and thirteen of the laws of eighteen hundred and eighty ; also chapter
one hundred and eighty-six of the laws of eighteen hundred and eighty
one; also chapters four hundred and eleven and four hundred and
forty-five of the laws of eighteen hundred and eighty-four ; also sec-
tion three hundred and fifty-six of the Penal Code. And also all acts
or parts of acts authorizing any incorporated school or college to con-
fer the degree of doctor of medicine causa honoris or ad eundem^ or
otherwise, than upon duly graduated students in course : and all other
acts or parts of acts inconsistent with this act are hereby repealed. And
it is provided that the degree of doctor of medicine conferred causa
honoris or ad eundem gradum, shall not be a qualification for the prac-
tice of physic and surgery in this State. And, whereas it is the pur-
pose of this act to codify the statutory provisions of this State regu-
lating the admission of individuals to the practice of physic and sur-
gery, and the punishment of those practicing either physic or surgery
without authority. It is further provided that tjie specific repeal herein
of any portion of an act that may have been heretofore repealed,
expressly or by implication, shall net be construed to revive the remain-
ing part thereof.

§ 10. Section ten shall embrace the following schedules, namely A,
B, C and D.

• •; 1 ..
.1

;. s
i •

> i

Pbockedings.

SCHEDULE A,

T<? #W whom it may concern, greeting :

A. B., having on the day of eighteen hundred and , pre-
sented to the faculty of , a diploma purporting to have been issued
on the day of , to said A. B., conferring on the degree of doc-
tor of medicine, and it being made certain to us by inquiry and
examination, that the said , at the date of said diploma, was a
medical college or school, duly incorporated, in good standing and
authorized to confer the degree of doctor of medicine, and also that
the said A. B. is the identical person upon whom the said diploma
was conferred, and is also a person of good moral character, who has
pursued a course of study equivalent to that required of a doctor of
medicine by said faculty, and is sufficiently well versed in the knowl-
edge of physic and surgery to qualify to practice the same.

Now, therefore, the said faculty have caused this indorsement and
the seal of the said to be placed upon said diploma.

(Signed) by the dean or proper officer.
~ [seal]

SCHEDULE B.

To all whom it may concern, greeting :

A. B., having on the day of presented to the faculty of
a license purporting to have been issued to said , as authority to

practice physic and surgery in all branches ; and it being made certain
to us by inquiry and examination that A. B. is the identical person on
whom the license was conferred ; that it is not necessary in the country
in which it was conferred, that a licensed practioner of physic and
surgery should have the degree of doctor of medicine, and that a
license in form and substance such as the one hereby indorsed is the
usual and sufficient authority to practice physic or surgery therein ;
and further, that said A. B. is a person of good moral character, who
has pursued a course of study equivalent to that required of a doctor
of medicine by our faculty, and is sufficiently versed in the knowledge
of physic and surgery to practice the same.

Now, therefore, the said faculty have caused this indorsement and
the seal of the said to be placed upon said license.

(Signed) by the dean or proper officer.

[seal.]

Thirty-Sixth Semi-Annual Meeting. 17

SCHEDULE C.

State of New York, )
County of f 88 ' '

being duly sworn says that h name is ; that

was born in on the day of , in the year ; that now

resides at number street, in the city of , and intends to

practice physic and surgery in the county of ; that h authority

so to practice is a license (or diploma), conferred upon h , on the

day of ,, in the year , by , a duly incorporated medical ,
school (or college), or a legally constituted board of medical examiners
of the State of New York, authorized at the date of conferring said

to confer the same, and being then in good standing ; (or in case
of a European license, describe the source thereof, and the authority
under which it was conferred). Affiant further says that is

the person named in the said , and had, before receiving the same,
fully and substantially complied with the requisities as to attendance, .
terms and amount of study and examinations required by the laws of
the State and the charter and regulations of said as preliminary
and necessary to the conferment thereof. Affiant further says that no
money was paid by for said except the regular fees paid by

all applicants therefor ; that no fraud, misrepresentation or mistake in
any material regard was employed by any one, or occurred, in order
that said should be conferred on affiant. (Where indorsement has
been made a license or diploma granted without the State, this addi-
tional clause shall be verified.)

And affiant further says that the said diploma or license was indorsed
on the day , eighteen hundred and , by the faculty of ,
upon satisfactory proof by affiant of all the facts hereinabove recited,
and that had followed a course of study equivalent to the curriculum
of said , and was competent to practice physic and surgery.

Sworn to before me, this )
day of J

SCHEDULE D.

To whom, it may concern : Know ye, that on the day of

A. JB., having first subscribed and verified an affidavit in the form of
schedule C of chapter of the laws of eighteen hundred and eighty

seven, made an entry in the register of physicians and surgeons, kept

Proceedings.

in the office of the clerk of county, of which entry I certify the
following to be a transcript :

NAME.

Birthplace.

Residence.

Date, source and

character of

license or diploma.

Indorsed by
what FACULTY.

Remarks.

In witness whereof I have set my hand and official seal this
day of

Clerk of county.

[Seal.]

§ 11. This act shall take effect immediately.

State of New York, }

Office of the Secretary of State, ) s ' '

1 have compared the preceding with the original law on file in this office,

and do hereby certify that the same is a correct transcript therefrom and of

the whole of said original law.

FREDERICK COOK,

Secretary of State.

On motion of Dr. Moffat, the thanks of the Society were tendered
to Drs. Paine, Bendell and Mb. Purrington for their able and effi-
cient labors in behalf of the Bill.

REPORT OF THE BUREAU OF OPHTHALMOLOGY.

A. B. Norton, M. D., Chairman. {For papers and discussion see
bureau report.)

REPORT OF THE BUREAU OF CLIMATOLOGY.

Charles E. Jones, M. D., Chairman. {For papers see bureau
report)

REPORT OF THE BUREAU OF CLINICAL MEDICINE.
H. L. Waldo, M. D., Chairman. {For papers see bureau report)

Adjourned.

Thibty-Sixth Semi- Annual Meeting. 19

EVENING SESSION.

Dr. Terry offered the following resolution, which was adopted :

Resolved, That it is the sentiment of this meeting that the Executive
Committee would be justified in permitting the publication of papers
read at this meeting elsewhere than in the Transactions of the Society.

REPORT OF THE BUREAU OF PAEDOLOGY.
W. C. Latimer, M. D., Chairman. (No papers.)

REPORT OF THE BUREAU OF VITAL STATISTICS.
A. E. Wright, M. D., Chairman. (No papers.)

REPORT OF THE BUREAU OF OTOLOGY.

Edwin J. Pratt, M. D., Chairman. (For papers and discussion
see bureau report?)

Moved by Dr. Houghton, seconded by Dr. Strong, that a Com-
mittee be appointed to take into consideration the financial condition
of the Society and devise ways to improve its general condition.

Carried.

Referred to the present Executive Committee to report at Annual
Meeting.

The Society then adjourned and partook of the hospitality of the
New York County Homoe6pathic Medical Society in a most enjoyable
collation, and listened to interesting addresses from Drs. Paine, R. C-
Moffat, Ball and MoMurray.

SECOND DAY— Wednesday.

Meeting called to order at 11:45 a. m. Dr. Houghton offered the
following resolution, which was adopted:

Resolved, That it is the sense of this meeting that in order to be
consistent in the publication of papers read at the sessions of this
Society the Executive Committee be requested to consider the matter
of publishing such papers as were rejected on account of the resolution
at the last Annual Meeting.

20 ' Proceedings.

REPORT OF THE BUREAU OF SURGERY.

J. M. Lee, M. D., Chairman. {For papers and discussion see
bureau report?)

REPORT OF THE BUREAU OF MENTAL AND NERVOUS DISEASES.

S. H. Talcott, M. D., Chairman. {For papers and discussion see
bureau report )

REPORT OF THE BUREAU OF OBSTETRICS.

Louis Faust, M. D., Chairman. {Jfo papers)

REPORT OF THE BUREAU OF HISTOLOGY.

Fred. S. Fulton, M., D., Chairman. {For papers see bureau report)

REPORT OF THE BUREAU OF GYNAECOLOGY.

Walter Y. Cowl, M. D., Chairman. {For papers see bureau re-
port)

The Secretary announced the following applications for membership:

Drs. J. Oscoe Chase, F. H. Boynton, Clarence E. Beebe, B. Gar-
rison, Charles McDowell, Arthur F. Eife, Eugene H. Porter, Stephen
H. Knight, C. Eurich, George T. Hawley, Joseph F. Land, L. L.
Danforth, Charles Deady, Alton G. Warner, Wm. T. Helmuth, jr.,
B. J. Burnett, Alexander Berghaus, Willliam H. Scott, Charles E.
Teets, W. U. Reynolds, E. D. Franklin, Virgil Thompson, H. M.
Dearborn, Edwin J. Pratt, New York City ; Edward P. Swift, Pleas-
antville.

Dr. Everitt Hasbrouok : Reference to the records of this Society
will show that our deceased member, Dr. Titus L. Brown, of Bing- \

hamton, ever had the interests of the Society largely at heart, and
attended its meetings with a regularity almost unprecedented. In
view of these features of our dead brother I move you that the Secre-
tary be instructed to send to the family of Dr. Brown a minute of our
special recognition of his worth as a colleague and member, and to
spread a copy of the same on the records of the Society.

Seconded and Carried.

Thirty-Sixth Semi- Ann dal Meeting. 21

The following resolution was offered by Dr. Boocock :

Whereas, It is currently reported that Robert Boocock, a member
of this Society has no legal standing as a practitioner of medicine ;
therefore

Resolved, That the Committee of this Society for the Southern
District be instructed to fully investigate the matter and report upon
the same at the Annual Meeting.

Adopted.

Moved and seconded that a vote of thanks be tendered the New
York County Homoeopathic Medical Society and the Local Com-
mittee of Arrangements for their generous hospitality.

Ccvrried.

On motion the Society adjourned.

22 Bureau of Materia Mediga.

REPORT

OF THE

BUKEAU OF MATERIA MEDICA.

E. H. WoLooTT, M. D. Chairman, - - Rochester.

Drs. F. F. Laird, Utica.

C. D. Hale, Syracuse.

M. A. Van Denburo, ... - Fort Edward.

W. W. Seeley, - Albany.

H. G. Preston, - - Brooklyn.

John 0. Otis, .... . Poughkeepsie.

* THE INDICATED REMEDY.

By Edwin H. Woloott, M. D.

ROCHESTER, N. Y.

As homoeopathists, this is a vital subject ; in fact, it may well be
considered the central truth of our profession. There is no field of
labor that promises so much, not only to us individually, but to the
cause we represent, as the selection of the indicated remedy. We,
ourselves, cannot expect to succeed, or contribute to the welfare of
homoeopathy, unless the pathogenetic effect of the remedy chosen
corresponds very nearly at least with the diseased condition. I
admit that it is often difficult to decide whether or not a certain remedy
is indicated, and that it frequently requires diligent and faithful study
to make the selection. Yet when it is found, we are so certain to
relieve, and perhaps effect a brilliant cure, that we do not for a moment
regret the effort. The question of the indicated remedy, whether we are
conscious of it or not, is ever before us. It requires our constant
thought and attention; no one subject so continually occupies our
mind, and nothing will so surely measure our success or decide our fail-
ure in practice.

* Semi- Annual Meeting 1886.

Bureau of Materia Medica. 23

We cannot afford to neglect or slight the corner-stone of homoeop-
athy. We are also called upon to decide whether the indicated remedy
is meant to include combinations, or medicines given alternately.

This question has been so frequently presented, and received so
much consideration, that I omit its discussion and produce, instead, a
series of cases from my note book, showing the action of the indicated
remedy, as a single remedy, in a variety of acute and chronic conditions.

Case I. — Etta, aged four years ; for a long time a subject of chronic
eczema affecting the external portions of the auditory canal and lobes
of both ears, as well as the greater portion of the tissue covering the
parietal and frontal bones. The ears were constantly discharging, the
lobes were congested and swollen, there were deep ffssurcs behind the earp
at their union with the adjacent integument and the parietal and frontal
regions were covered with a scaly like substance. The inflammation had
been sufficient to destroy the growth of hair and produce marked dis-
figuration of the tissues involved. This condition of the child had
been existing nearly two years, notwithstanding the treatment adminis-
tered by several physicians. After having been under my care for
about two months I gave Graph. 3x three times a day. In a week a
marked improvement was apparent ; the remedy was continued for two
or three weeks longer, when it was noticed that the child was getting
deaf. After withholding the remedy for a week the hearing returned.
I continued this treatment for some time, occasionally being obliged to
discontinue the remedy for a short time on account of the deafness;
meantime the disease gradually abating, not so marked, however,
when the medicine was withheld as when it was administered. It was
now plain to be seen that this remedy was indicated, but perhaps not
the right potency. It was then given in the 30th for a month or two,
with continued improvement and without a return of the deafness.

It would be difficult to decide whether the improvement was due to
the change of potency or whether a sufficient amount of the 3x had
been absorbed to complete the cure without further administration.

It would be equally difficult to decide whether the 3rd cured too
rapidly or produced a metastasis to the internal auditory apparatus.
When she had nearly recovered the vaccination craze reached the
city and she was vaccinated, with the hope that it might assist in a rad-
ical cure. This not only made a very sore arm for a month or more
but caused the eruption about the ears to reappear as before. After
the disturbance from vaccination had subsided, Rhus tox was given for
a short time and the cure was completed. It is now nine months since
we have seen any sign of the eczema.

* r r *:

24 Bureau of Materia Medica.

Case II. — Baby three months old, with an eruption about the
genitals and anus, of a very red character. Different remedies were
used without benefit, when it was discovered that the mother, who was
nursing the child, had a high sp. gr. of the urine and a marked ten-
dency to sugar. Thinking that the eruption on the baby was similar
to or identical with the pruritis that sometimes accompanies this con-
dition, a few powders of Kreosotum 3x were given to the mother,
which promptly cured the baby.

Case III. — Miss C, aged twenty; with an indolent ulcer of the
limb for six months. It was half an inch deep and three or four
inches in diameter. Before she came under my care, an " old school ,?
physician had been flBing flaxseed poultices, which rather aggravated
than benefited the trouble. At my second or third visit she explained
how she happened to lose one eye ; of course I had noticed the loss,
but did not refer to it especially, as it did not occur to me that it had
any connection with the case. However, when she told me that it
" ran out " when she was quite a small child, she gave me a suggestion
that led to the selection of the remedy which cured the case.

I suspected hereditary syphilis, and accordingly gave the Biniodide
in solution. In three days there was a change for the better and in a
month the ulcer was healed. This was the only treatment except the
occasional use of Argentum nit. as a caustic. This case, and the one
next preceding, would seem to suggest the importance of a correct
diagnosis.

Case IV. — Mrs. A., aged fifty-seven, complained of a griping, pinch-
ing pain in the umbilical region, which would come suddenly, remain
two or three minutes and then entirely disappear for nearly five
minutes, to return as before. It was relieved by motion, and followed
by marked prostration. Other symptoms and conditions were: tongue
dry ; face pale ; very nervous and restless ; pulse weak ; and an old
Quinine and malarial subject. Ars. one powder on the tongue gave
immediate relief, and cured promptly.

Case Y. — Mrs. B., aged thirty, and mother of two children. Epilep-
tiform convulsions during menstruation. Actea promptly ^relieved, and
trouble has not returned for several months. Her second child, three
years, was attacked with chorea one year after birth. Several remedies
have since been given with little or no avail until I decided to give
Actea because of its action on the mother. The remedy has been taken
only a short time, but marked improvement is apparent. I relate these
two cases to show that by the good effect of Actea in each we have

Bureau of Materia Medica. 25

reason to believe that the two diseases stand related to each other as
cause and effect. If this be true it follows that a nervous disorder of
the mother may manifest itself in a different form in her child.

Case VI. — Mi6s H., aged twenty-four. Complains of a loose cough
in the morning for half an hour after rising ; during the day it becomes
tight, pains constantly under the left shoulder blade extending down-
ward and forward, heart feels constricted, breathing normal, yet a
peculiar sensation is present. When the cough is relieved the pain is
aggravated. The pain is of a throbbing character and is confined to the
left side. Another important symptom, although not occurring more
than once or twice a year, is a pulmonary hemorrhage, at times amount-
ing to a severe loss of blood. Cactus grand, was given and followed
by immediate relief and a permanent cure.

Case VII. — Mrs. Q., aged twenty-six. Light-haired, German, and
mother of three children. Has complained of a very severe intermit-
tent neuralgic headache of the right side of the head, and especially of
right eye, every seventh or eighth day for nearly four years ; particu-
larly when nursing children. The pain usually begins in the morning,
with a dizzy sensation in the top of the head, and will increase in
severity for an hour, when it will be at its greatest intensity. It will
then settle in the right eye, supraorbital arch, and retrain for twenty-
four hours, when it will, quite suddenly, disappear to return again in
about a week. The pain is of a lancinating character, and seems as if
knives were being thrust in both the eye and temple and as though the
eye must be held in to prevent its protrusion.

At the beginning of each attack there is fainting, nausea, and vomit-
ing, also pains extending into the bowels and ovaries. The neuralgia
is aggravated by light, noise, and talking, and is partially relieved by
warmth. Sept. 6th Silicea 3x was given, after repeated trials and
failures with other remedies.

Sept. 20th, she said the headache had been delayed four or five days,
and it had not been so severe as formerly, nor had it affected the stom-
ach. The remedy was continued. Oct. 6th, no return of neuralgia to
this date. Oct. 15th, headache as usual. Soon after this she was con-
fined to her bed for ten days with malarial fever and neuralgic head-
ache. During this attack Ars. was given and followed by brilliant
results. The fever and neuralgia quickly disappeared and for several
months now have not returned.

I think we may learn from this case that the indicated remedy can
make a profound impression on some diseased conditions that are for

26 ' Bureau of Materia Mrdica.

the present incurable, but which after they have spent their force yield
readily to treatment.

Case VIII. — Mr. L., college boy, has complained of a hacking cough
for three weeks, which was caused, undoubtedly, by cold and public
speaking. There was a tickling sensation in the supra sternal fossa.

The cough seemed to be aggravated .from four to eight p. m., and
relieved by lying down and during the night. I made an exhaustive
study of the materia medica and gave eight or ten prescriptions with-
out the slightest benefit. He, naturally, became discouraged and bought
a bottle of cough syrup, which completely cured him in two or three
days. In this case 1 believe that the Morphine in the compound did
the work, simply by relieving the irritation. No doubt there is a
remedy that would have effected a cure, but I did not find it.

MEDIUM OF DRUG ACTION

By B. S. Partridge, M. D.,

EAST BLOOMFIELD, N Y.

Nearly a century ago there lived a celebrated French physiologist,
Bichat, who announced the opinion that man possessed two nervous
systems, and passed two kinds of life. One of these systems, — the one
common to all organic life, — he called the vegetative or sympathetic ;
the other he denominated the nervous system of animal life, or cerebro-
spinal system. More recent investigations have established and demon-
strated the existence and office of these two systems.

The first, which we will denominate the organic nervous system,
presides over and controls all of the functions essential to mere organic
(animal or vegetable) existence, viz: innervation, nutrition, respira-
tion, circulation, secretion and excretion. This is physiological life.

The second class of nerves, called the cerebro-spinal, is not essential
to animal life, but is an adjunct to enable its possessor to hear, see,
smell, taste, feel and move, comprehend, combine, reason, appreciate,
etc. This cerebro-spinal system derives its circulation and nutrition
through the organic system, with which it is connected in a most
intricate manner.

Bureau of Materia Medica. 27

No organism, whether animal or vegetable, can survive a moment
without innervation. Charles Darwin has shown that all vegetable
life is endowed with innervation, by which the functions of circula-
tion, nutrition, respiration, secretion and excretion are performed. All
forms of life are possessed of organs adapted to the performance of
these functions, and these organs are under the control of innervation.
Matteucci, Claude Bernard, Brown Sequard and others, have shown
by extended and careful experiments, that the functions of any organ
or part depends upon the integrity of its nervous supply, and only
through some branch of the sympathetic, can any influence be exerted
upon any of the functions of the organism.

The normal performance of these functions constitutes health. In
their aberration or disturbance we observe disease. Deprive the ani-
mal or the vegetable of the power to perform any one of these essen-
tial functions, and death will inevitably follow.

Hahnemann says : " All morbid influences produce their effects,
establishing disease, by disturbing the functions and feelings of the
body." Since these functions are directly under the control of the
organic nervous system, it must follow that all these morbid influences
act through this system of nerves upon the various functions of the
body.

Hahnemann also tells us that the sensitive nerves receive drug im-
pressions and transmit them almost instantly to all parts of the body.

It seems to be the property of this system to receive the peculiar
impression of any drug, and convey this impression in some mysterious
way to a remote part or organ which that drug is known to influ-
ence. The modus operandi is inexplicable.

If we study the anatomy of this vast ganglionic system of nerves,
we shall find that there is a great tendency to form intricate plexuses,
which encircle the blood vessels and follow them to the viscera. From
these plexuses are derived the vaso-motor nerves, which control the
circulation. Through these each organ is supplied with a proper
amount of blood for the normal performance of its function. If by
any morbid influence there should be either excess or deficiency of
blood in any part, the function would be increased or diminished, and
disease would exist. Now the vaso-motor nerves control also the cir-
culation in the brain and spinal cord. Hence any deviation from the
normal functionalism of the cerebro-spinal system is traceable to some
influence acting through the vaso-motors. Thus we have through gen-
eral or localized cerebral hyperaemia, hallucinations, or mental aberra-
tions. And so we come to the conclusion that morbific agents act,

28 Bureau of Materia Medica.

not through the cerebro-spinal system, but upon the vaso-motors that
control the circulation in the brain and cord.

Again, mental impressions often act through the vaso-motors to pro-
duce some deviation from normal functionalism. How often do we
see a perturbed mental state almost suspend the normal secretion of
the gastric juice. In other cases a sudden emotion will occasion an
excessive flow of urine. In the one case, the blood vessels of the
gastric mucous membrane fail to dilate as in functional hyperemia,
while in the other, dilatation of the renal vessels takes place in response
to an influence exerted through the vaso-motors.

Drugs, when taken into the system, act as irritants producing stim-
ulation or excitation. They act, not upon passive tissues, such as bone,
tendons, muscles, or blood, for these are insensible and could yield no
response to irritation; but they act rather upon nerve tissue, which
alone is susceptible of irritability, and through the nerves produce
their peculiar effects upon the functions of the body.

These effects differ in no essential respect from the influence of so-
called natural causes of disease.

It is by virtue of this irritant property of drugs that they become,
under the law of similars, the agents curative in the hands of the thera-
peutist. And it is through this great organic nervous system, which
controls all physiological processes, that drugs are capable both of pro-
ducing and of curing disease.

The Single Remedy.

By Edwin H. Woloott, M. D.

ROCHESTER, N. Y.

Hahnemann many years ago, said that "In the treatment of disease
only one simple medicinal substance should be used at a time."

By admitting the unity of disease we will at once accept this as a
practical statement and one that can be demonstrated on scientific
principles. Many an argument has been made and many pages written
defending combinations and alternations, but the weight of testimony
is with the single remedy, which should always be our ideal in practice.

ST*

Bubeau of Materia Medica. 29

Any other coarse than this would lead as back to the field of "unmeth-
odized clinical experience" back to empiricism and polypharmacy.
It will be admitted that our practice is not up to our theory and that
oar present knowledge is not sufficient to make it always safe to rely
on the single remedy, yet we cannot for a moment doubt the truth-
fulness and universality of the law.

In this, as in every other field of research, the mark is always higher
than we practically attain. This is a necessity, otherwise all could not
aspire, by reason of intellectual inequality. There are instances when
with our incompleted materia medica absolute adherance to the rule
of the single remedy would seem impracticable. Such cases do not
argue against the principle we profess to follow ; they admit simply
that the intellectual attainments of the physician have not yet reached
that state of perfection which makes this course possible in all cases.
We are glad to note that while we are following our illustrious leader
in giving the single remedy, our friends of the non-homoeopathic
school have made decided progress in this direction. The famous
prescription of Andromachus containing sixty-four drugs, has disap-
peared, and we have now the convenient tablet triturate which seems
to be common stamping ground for many physicians in both schools of
medicine. They, as well as we, are passing from conglomeration to
individualization, and are fast assigning each and every drug to its
proper place, surrounding it by its own specifications and limita-
tions, being more definite and particular and thus progressive. It
is often the question with them, as it always should be with us,
is this a case of Nux vomica or Pulsatilla ? And not one of Nux
vomica and Pulsatilla.

This advancement is also in keeping with that made in the collateral
sciences; in biology the different anamalculse and bacteria are each
receiving attention and study, and are being definitely understood It
is not enough that electricity is indicated, but the quality and quantity
are absolutely necessary if we would effect relief.

The microscope furnishes a ready illustration in that it is not suffi-
cient that epithelium is present in a given specimen of urine, but the
kind is wanted, as differentiating between renal and cystic disease.
The single remedy in medicine is therefore a direct product and
natural result of scientific investigation. On this basis we can claim
the recognition and support of intelligent men ; on this basis the
declaration of Hahnemann means something more than a simple asser-
tion ; on this basis the single remedy will stand forever.

30 Bureau of Materia Medica.

We are thus tending more and more towards definiteness and
individualization of drags ; and the time is coming when each shall
have its own place in the materia medica, not that we may ever expect
that a homoeopathic prescription will be a drastic cathartic or a power-
ful emetic but that it will reign supreme "within its sphere" and
conglomeration and alternation will be a thing of the past.

HAHNEMANN'S WRITINGS AND RUBRICK.

By M. W. Van Denbueg, A. M., M. D.

FORT EDWARD, N. Y.

No stronger proof of Hahnemann's greatness is needed than the
immense influence his thought has gained over the medical world dur-
ing the past half century. Though less than that since he died, full
of years and of honors, yet half a century may be assumed as having
elapsed since his literary work was completed and his doctrines fully
established.

Our own is preeminently an age of revisions. But the works of
few men have been so little subjected to this process as those ot
Hahnemann. What he did, and what he left as monuments of his
labors, have been regarded with almost religious veneration.

It seldom falls to the lot of any man to have his entire work, after
the lapse of half a century, still held in such reverence.

The advance of knowledge during the last fifty years has necessi-
tated revisions in nearly every branch of science. Progress always
demands changes. Why then have the works of Hahnemann escaped ?
It will be worth our while to pursue this inquiry. His literary and
scientific works may be classified under four heads.

First — The discovery and establishment of the law of similia.

Second — His drug provings, or Materia Medica Pura.*

Third — His Philosophical Writings.

Fourth — His Polemical Writings.

Concerning the discovery of the law of similia it can be truly said
this is ample glory for one man. Though it should be proven that he
had failed in everything else, yet in that he succeeded in firmly plant-

Bureau of Materia Medica. . 31

ing this one truth in medical science, Hahnemann's immortality was
assured. He thenceforth securely took his place among the few uni-
versal heroes.

Passing, for the present, the second on the list, we come to his
Philosophical Writings. These must of necessity fade away in part, if
not altogether.

Carroll Dunham has felicitously said : " A man's observations of
natural phenomina, if he be a keen and accurate observer, as Hahne-
mann unquestionably was, are generally correct; but his theoretical
explanations of them are pretty certain to be tinctured with the pre-
vailing philosophy of the times in which he lived, and are not likely
to be accepted without modification by men of a later period."

This is a universal law, conditioned upon the advancement of knowl-
edge. The philosophy of Hahnemann did not rise far enough above
his times to escape its force. His theoretical and speculative explana-
tions will be demolished and buried out of sight by the relentless
march of time. But there are also many coins from his brain that
bear the stamp of universality and have the ring of pure metal. Many
such are found in the Organon, but many others are there mixed with
them that have long since ceased to pass current, and Hahnemann,
were he living in this age, would be the first to repudiate them.

Of the solid gold are such as relate to the application of the law
of similia to a given case ; how to study your patient ; how to study
your remedy. These are not theoretical deductions, but scientific
observations.

The fourth and last division is the Polemical Writings. These
are found scattered everywhere in all Hahnemann wrote except Materia
Medica Pura. They have seen their greatest day, and have largely
accomplished the object whereto they were sent forth, in mollifying
the "regular barbarity" of treating diseases. No greater boon has
ever been bestowed by one man upon suffering humanity than the
modification and moderation brought about by Hahnemann in the
administration of drugs. The entire civilized world, to the farthest
limit of European influence, has felt his beneficent touch, and does
not today know one tithe of the gratitude it owes this heroic man.

Returning now to the second division of the analysis of Hahne-
mann's works, the Materia Medica Pnra, we find that his influence on
this department has been autocratic. The materia medica of to-day
bears in every part, and on every line, the stamp of his sign manual.

The factors of Hahnemann's Materia Medica, are three :

First — The observation of drug phenomena.

32 Bureau of Materia Medica.

Second — The manner of recording those observations.

Third — The method of arranging them.

Of the first it is pretty safe to say Hahnemann's skill has seldom
been equaled, and probably never surpassed, in keen, accurate and
thorough observation. Subsequent investigation has tended for the
most part to confirm rather than supplant his personal pathogenesy.
But this is not true of all he recorded. Others observed and he
accepted their record. These symptoms are not always trustworthy.

The second factor, his method of recording observed drug phenom-
ena, is still in full vogue, and is about equally conspicuous for. its
virtues and its faults.

The short, crisp sentences ; the sharp isolation of each incident and
its careful individualization, are in several ways elements of strength.
They tend, though they do not compel, to any equally careful analysis
of the symptoms of the patient. They enable us to make clear dis-
tinctions between different drugs. They tend to individualize various
phases of the same disease in different epidemics and in different
cases. These are no doubt valuable points in applying the great law
of cure.

But on the other hand, by this process of isolation the concomitance
of drug symptoms is hopelessly broken up, and they are likely to
remain permanently scattered to the four winds of heaven, thereby
destroying one of the most valuable elements in pathogenesy.

With the present state of our materia medica no task is more labori-
ous than the construction of a complete picture of concomitant symp-
toms. Yet on this, more than on any other one element, depends the
successful employment of homoeopathic remedies.

Under the present arrangement of cutting each symptom off by
itself a half-dozen concomitant symptoms may be scattered, each
restricted to less than one line, through half a dozen or a dozen pages,
and the task of reconstruction rendered impossible. One of the ele-
ments of failure of homoeopathic drugs is the want of concomitance.
Let me not be misunderstood. A given drug is selected, one, we will
say, that has four symptoms which correspond with four leading symp-
toms in the patient. Two of these drug symptoms have never been
evolved in connection with the other two in any proving of the drug.
But two other symptoms have always attended the first two in the
drug provings, and are entirely wanting in the patient. The doctor
thinks he has four good corresponding symptoms, whereas he has only
two, and these two are disassociated with their constant concomitants.
How is he to know this from the study of his books ? What is the

33
Ires reported

Hahnemann.

Confusion, &o.
Pain in Head.
Outer Head.
Face in Gen.
Eyes.

Jaws and Glands.

Ears.

Nose.

Lips.

Lower Jaw.

Larynx.

Teeth and Saliva.

Mouth.

Tongue.

Speech.

Mouth in Gen. j

Tonsils and Throat. |

Deglutition. i

Taste.

Appetite.

Eructations.

Nausea and Vom.

Hiccough.

Stomach.

Abdomen.

Bowels.

Stool.

Urine.

Genitalia.

Catarrh and Cough,

Coryza.

Chest.

Respiration and
Skin of Chest,
Breasts (Fem.)

Spinal Column.

BacSand Scapulae.
Shoulders.

Upper Extrem.
Lower **
Skin of L. "
Limbs in Gen. ■

Restlessnes & Mood!

Sleep.

Dreams.

Thirst.

Chills and Coldness,

Fever.

Inflammation.

Rash.

Sweat.

Anxiety.

Delirium and Its

Moods.
Madness.

most contra-
ki from each
ad without a
ft.

Lis preface:
B on materia
Bst array of
comparative
le stands dis-
' subject will
rsterious awe,
tprehend."

[ahnemann is
terated to-day
teria medica,
f the totality
No man can

day books of
tot ? Because
irae, a bushel
ve found the

Certainly no
anything else.

we of to-day.
ledy. In his
t the present
; from expen-
se of ref resh-

^anderbilts, it
ie nation. It

3pace demand
re important f

rpowering. A
^rom Hahne-

34 Bubeatt of Materia Medio a.

mann down to the present, will show this more clearly than mere des-
sertation.

It is but fair to say he has been copied, without improvement or
change of importance, down to the time Dr. B. F. Underwood's little
work on materia medica appeared. Dr. Underwood made quite a
radical change, but not radical enough to remedy the evil.

A superficial survey of the Hahnemannian arrangement leads to the
conclusion that the fundamental idea is anatomical relationship.

A more careful examination reveals the fact, that in part at least, it
is physiological, while incidents purely mental, moral, or vital, are put
in haphazard, with very little regard to relationship.

To be specific, the Hahnemannian arrangement of Belladonna symp-
toms are after this sort :

Beginning with Confusion, a mental symptom, there follows Pain
in the Head, a nervous symptom; Outer Head, a combination of nervous,
tissue and skin symptoms ; Face in General, combining all three and
adding a fourth ; Expression, a vital symptom ; Eyes, a special sense,
hence, functional, tissue, nervous symptoms combined ; Jaws and
Glands; Ears, another special sense; Nose, a combination of respiratory,
special sense, tissue and skin symptoms ; Lips, Lower Jaw, Larynx ;
again respiratory symptoms mixed with several other classes, one of
which is the functional Voice, Teeth and Saliva, Mouth, Tongue,
Speech, Mouth in General, Tonsils and Throat, Deglutition, Taste,
Appetite, Eructation, Nawea and Vomiting, Hiccough, Stomach,
Abdomen, Bowels, Stool.

If now we attentively examine the order down to tonsils and throat,
and perhaps one or two groups beyond, of a functional nature, the dom-
inant idea of arrangement, seems to be anatomical relationship.

But beyond this point, that idea ceases, for the time, to guide ; else,
why do we not have Bronchi, Lungs, Heart, Respiration and Circula-
tion, the symptoms under Chest, precede Stomach, Bowels, etc.

The reason for the present arrangement is the physiological connec-
tion of the parts, and the absurdity of the anatomical idea that was
apparent at first, becomes now intolerable ; hence the change.

From this point on we have a strange medley. Sometimes the ana-
tomical idea prevails, but more often the physiological, and frequently
the struggle between, the two, is only too evident in the manifest
absurdity of the decision.

Taking up the Kubrick at the point already reached, we have the
physiologically connected Genito- Urinary systems in the following

Bubeau of Materia Medioa. 35

order : Urine, Male Organs, Female Organs, (but not the female
breasts).

Again, we take up next the physiologically connected Respiratory
System, Catarrh. We have had Nose (and frontal sinuses implied,)
a long way back, and must now go back for it, if we want the connec-
tion complete, Cough, Goryza, Chest, (meaning lungs, Bronchi, Heart
and Circulation in part at least,) Shin of Chest, and Female Breasts.

Here was a grand struggle for dominance between the two ideas, and
anatomy won the day. "What advantage materia medica gained thereby
is not apparent.

Next on the list is, Spinal Column, Bach and Scapulce, Shoulders,
Upper Extremities, Lower Extremities, Shin of Lower Extremities,
Limbs in General; a good list of tissue symptoms, together with a
large part of the nervous system and a patch of skin symptoms thrown
in to complete the bargain.

At the very beginning was placed a mental symptom, Confusion.
This we have experienced more or less all the way down to the present,
and now we meet for the first time with congeners, Restlessness and
Moods.

Closely allied are Sleep and Dreams, but Thirst again trips us up.
Taken, however, together with what follows it is not so bad : Thirst,
Chills and Coldness, Fever, Inflammations, Rash, Sweat. Here are
fever phenomena, tissue phenomena, that may or may not be attended
by general fever, and skin phenomena that also may or may not occur
with febrile excitement, placed between two elements of the febrile
movement.

And now, once more, we come upon purely mental phenomena :
Anxiety, Delirium and its Moods; Madness.

It would seem little less than madness to justify such an arrangement
as this in this day and at this stage of progress.

The most that has been done is to patch up some of the most glaring
defects. A hasty comparison of the prevailing Kubrick with Hahne-
mann's own will show how true this is.

It is not incumbent upon us, as good and faithful disciples of Hahne-
man, to copy his faults as well as his virtues. Neither are we called
upon to regard him as inspired or infallible. He himself would be
the first to repudiate such implications. It is rather our part to inquire,
in the calmest scientific spirit, what is required of Materia Medica
Pur a f

The first requirement is that it be truthful. The universality of the
law of similia is not here under discussion, only materia medica. The

36 Bureau of Materia Medic a.

second requirement is that it should be available for use with the least
possible expenditure of time and labor.

Efforts in this direction have been untiring. We have condensed
and recondensed materia medicas ; repertories large and small have
consumed years of patient labor, and helped in a very large degree to
make up for deficiencies and confusion. Without them it is hard to
see how we could practice medicine at all.

But candidly considered, we have not yet reached perfection. The
truthfulness of the greater part of Hahnemann's work has been con-
ceded. So also the investigations of many others now incorporated in
the common stock. That there is need of still further sifting and
exclusion is not denied ; but this is not now the most important desid-
eratum. It is of vastly greater importance that the second requirement,
the availability, be considered. This is indeed the great question of
all others presented for our solution at this stage of the history of
homoeopathy.

Material has so multiplied on our hands that it is simply impossible
for any one man to use rao;e than a third or a fourth part of the drugs
on our lists. Of the thousand and more drugs accredited to Homoe-
opathy no one man uses, first and last, above four hundred. In some
statistics I have been collecting during the past year, no man has
reported more than three hundred and twenty-five drugs as used by
himself. Our own Dr. §. Lillienthal reported one hundred and twenty-
five as the limit of his repertory. The large majority of drugs put
down in the books are superfluous.

But when the number has been reduced to something like a reason-
able limit, the requirement of availability is not yet met. As has been
said, a radical change must be made in the arrangement.

No navigator ever yet sailed by two irreconcilable charts and avoided
the rocks, except by sheer good luck. Neither his skill nor his science
were to be praised if he escaped shipwreck.

Materia Medica arranged under two ideas, as irreconcilable as ana-
tomical relation and physiological connection, can but be confused and
confusing. Either the one principle or the other, or some third one
differing from either, must be followed consistently, or failure must
ensue.

We are called upon as physicians to study living and not dead phe-
nomena ; hence physiological and not anatomical.

To render materia medica available in the highest degree, the arrange-
ment of its symptoms should correspond as nearly as may* be to the
order in which they are likely to appear in the patient. This is in the

Bureau of Materia Medica. 37

physiological order, hence the physiological is most likely to be the
proper fundamental idea.

Such a basis involves an entire reconstruction of the Hahnemannian
Kubrick.

Under the physiological arrangement the following general heads are
proposed :

First. The Moral and Mental Phenomena and the Nervous System.

Second. The Respiratory and Circulatory Systems.

Third. The Digestive System.

Fourth. The Genito-Urinary System.

Fifth. The Muscular, Fibrous and Osseous Systems.

Sixth. The Skin and Superficial Glandular Systems.

The Fourth, the Genito-Urinary System, may be included under
two distinct heads or combined in one, it is not material either way.

The various symptoms now given under each drug will be grouped
conformably with this arrangement.

Materia Medica classified in this way will be made more available for
the following reasons :

First. The scheme is readily comprehensible, thereby avoiding con-
fusion.

Second. A comprehensive view of the drug and its sphere of
physiological action is more readily obtained.

Thiri. As has been already intimated, it will more merely corres-
pond to the grouping manifested by the symptoms of the patient.

Fourth. The order is the same as that employed in other text-books
on kindred topics, physiology, pathology and physical diagnosis.
Hence no new order will need to be learned.

But this rearrangement here proposed will not remedy all the evils
of the present system.

One already mentioned will be removed in only a very slight degree,
that is the lack of concomitance of symptoms, under the present
arrangement.

A method of lettering or numbering, or in some other way indicat-
ing such symptoms as are concomitant, would help in part, but noth-
ing will ever fully atone for the complete and exclusive picture of drug
action at a given stage of its pathogenesy.

This demands another basis of treatment than that proposed in the
Physiological Arrangement.

In addition to the reasons already given for the proposed change one
more deserves our thoughtful consideration. A decided gain may
rightfully be expected from the ranks of " our friends, the enemy. "

38 . Bureau of Materia Medioa.

Homoeopathy is still in the minority, and very largely so. It has
grown vigorously, but not so fast as it might have done had we
possessed a more readily comprehensible materia medica. The two
schools are drawing nearer to each other every year, but the concessions
of homoeopathy are as nothing compared to those made by the other
school. We have not abated one jot or tittle from our main principle,
the law of similia.

On the other hand the leading drug houses of the other practice
throughout the land are vieing with each other to see who shall
place on the market the largest line of tablet triturates in doses small
enough to make the skeletons of the allopaths of the last generation
rattle in their graves with indignation. Our allopathic brethern are
learning the efficacy of small doses, and if their manufacturers improve
during the coming three years at the rate of the last three, high potency
homoeopaths may obtain their supplies from almost any allopathic
house.

If now we offer them a comprehensible materia medica, we shall
yet many of us live to see the day when homoeopathy will be in the
majority, and not as now only a respectable minority.

Homoeopathy is botind to be the medical science of the future, for
it possesses the fundamental truth of the healing art.

With us of to-day rests the responsibility of helping or hindering
this consummation.

DISCUSSION.

Dr. Van Denburg : I have been collecting statistics on the use of
drugs for over a year past, and would like an expression in regard to
the use of the " single remedy." I find many of our best men all over
the country alternate very frequently in using drugs. Personally I
alternate more than I wish I did. My finest results have been obtained
with the u single remedy."

Dr. A. S. Ball : Related his conversion to homoeopathy. As an
old school physician, he was treating a case of meningitis which he
failed to benefit. He then privately consulted a homoeopathic physi-
cian, who suggested the use of Bell. 3x, which produced an aggrava-

..j

Bureau of Materia Medioa. 39

tion on the second dose. The remedy was suspended and improvement
continued until the tenth day, when Phos. was substituted and fol-
lowed by Hepar, which completed the cure.

Dr. Gorham believes it more satisfactory to use the single remedy.
In chronic cases he prescribes but one remedy, while in acute cases he
gets better results by alternation.

Dr. Beldin : The Monotropa uniflora may be classed in the old
adage as " death on fits." In convulsions produced by an injury to
the head, by a fall or otherwise, I have never known it to fail to bring
about perfect convalescence. I have used it in a case where there was
continued convulsive tremor, which had lasted fourteen hours.
Although it had been under regular treatment with Bromide of Pot-
assium all that time without any relief, Monotropa, ten drops of the
tincture in a gill of water, a teaspoonful every half hour, relieved the
spasm in one hour ; recovery perfect.

Pathology is all very well, but of what benefit is it if the drug has
not been proven ? Must we give up the use of all drugs known to
cure certain diseases simply because there is no pathology attached to
them ?

Dr. Everttt Hasbrouck failed to get any beneficial results from
Monotropa.

Dr McMurray : In selecting our remedies think we take too little
account of the pathological conditions. Must find out what the trouble
is. Our school has been too great a slave of symptomatology.

Dr. John L. Moffat: Reliance upon subjective symptoms is
one of the weak points in our school. A knowledge of the physio-
logical and pathological action of each drug is essential to its proper
study and its application to the totality of symptoms.

Another crying evil among us is such empirical reports as this
" cure of fits " just presented. Except as an example of how not to
do it, the time of this Society should not be wasted over such unscien-
tific, crude assertions. There can be no specific for u fits." If we are
to learn anything from our brother's experience in this instance he
should have presented the symptoms and history of one or more cases
so clearly that we could each of us corroborate his diagnosis, and then
should have demonstrated that no other change in the patient's environ-
ment but the ingestion of this medicine could have caused the disap-
pearance of the symptoms.

As to the single remedy, I must confess that I alternate in a large

40 Bureau of Materia Medica.

proportion of ray prescriptions ; but when I do cure, my most prompt
and satisfactory results have been from the single remedy, and this
fully as frequently in acute as in chronic cases. Alternation is mostly
habit (and a bad one), but is also a confession of ignorance or uncer-
tainty. However great the benefit to our patients, such clinical
results deserve no place in our literature and societies ; they teach us
so little that our time can be better occupied otherwise.

Dr. Boooock : We often alternate, because we are afraid to risk a
single remedy. It is hard to get out of the rut of alternation.

Dr. Henry M. Smith : It is my practice to use a single remedy,
and am sometimes led to its selection by one or two symptoms. Dr.
Hering said three legs were necessary for a stool to stand on, so if you
had three prominent symptoms of a drug to guide you, you would fre-
quently find that the pathogenesy of the drug would also embrace
many of the other symptoms of your patients. This view was also
held by Boenninghausen. One indication for Cina, given me by Dr.
Dunham, where, in intermittent fever the chill begins at the top and
runs down the spinal column, has served me in other cases than inter-
mittents. I have prescribed Ferrum phos. 6, with success in the
commencement of inflammatory conditions where Aconite has usually
been given, and in one case of intermittent fever, I first saw in
the second paroxysm, this remedy given during the fever was the only
medicine exhibited, the patient having no subsequent attack.

REPORT

OF THE

• BUREAU OF OBSTETRICS.

(1886.)

Evkritt Hasbrouck, M. D., Chairman, - - Brooklyn.
D«8. Wm. N. Guernsey, l New York City.

Phosbb J. Waite, New York City.

W. W. Blackman, .... Brooklyn.

Henry Minton, - Brooklyn.

George E. Gorh am, - . - - Albany.

J. N. Tilden, Peekskill.

W. H. Proctor, - Bingham ton.

Edwin Fanohbr, Middletown.

C A. Groves, Ticonderoga.

J. W. Candee, Syracuse.

Wm. A. Allen, Flushing.

S. P. Burdick, ----- Oakland, Cal.

D. B. Stumpf, Buffalo.

Disputants: Drs. L. L. Danforth, New York City.

J. Nicholas Mitchell, Philadelphia, Pa.

ALBUMINURIA OF PREGNANCY.

CAUSATION.

W. W. Blackman, M. D.,

BROOKLYN, N. Y.

In discussing the causes of the albuminuria of pregnancy we shall
exclude such causes of renal disease as exposure to cold when the body
is overheated ; its predisposition from scarlatina or any other acciden-
tally present etiological influence, and confine ourselves to the consider-
ation of this pathological condition which is really due to pregnancy
itself.

*No report from Bureau of 1887.

42 v Bureau of Obstetkics.

*
As a disease, dependent entirely upon the pregnant state, little or
nothing was known of it until a comparatively recent date. It is
now known to be one of the most f requent complications of pregnancy.
It is so trivial sometimes as to cause "no disturbance of pregnancy or
parturition," while on the other hand %4 it may give rise to most alarm-
ing and dangerous syniptoms in the pregnant, the parturient, and the
puerperal woman."

Albuminuria is no longer regarded as a symptom of Bright's disease
only, and it is probable that in 90 per cent, of the cases of albuminuria
of pregnancy the structural lesions of the kidneys, implied by the term
Bright's disease, do not exist. Indeed it has been shown recently that
the albumen of Bright's disease and that found in the albuminous urine
of pregnancy are not identical in character. Chemical reactions show con-
clusively that the albumen of Bright's disease is essentially different
from that found in the temporary albuminuria of pregnancy. " The
albumen of Bright's disease when brought in contact with the Oxide of
Copper, assumes a beautiful redish, violet color and produces a more or
less abundant flocculent, black precipitate." Now "the urinary albumen
of pregnancy, when Bright's disease does not exist, while it coagulates
readily by heat and Nitric acid, does not exhibit any such reaction with
the Oxide of Copper."

Why should albuminuria so commonly exist during the pregnant
state is a question that naturally arises.

Statistics show that a majority of cases occur under certain conditions
and from these facts various theories have been deducted. Albu-
minuria makes its appearance most frequently during the latter months
of gestation ; attacks primiparae more commonly than women who
have already borne children ; in multiple pregnancies it is seldom absent;
it occurs oftener in young women than those of a more advanced age ;
it ceases at once or soon after the pregnancy is over. It attacks preg-
nant women in every class of life ; occupation and habits are without
influence in its production ; it is found in robust, plethoric women as
well as those of a more feeble habit. It may complicate one pregnancy,
be absent in the next and recur again in the third. Rayer reports a
case where it was developed for the "first time during the seventeenth
pregnancy in a woman who had previously passed through sixteen per-
fectly regular and uncomplicated pregnancies." It has been found that
hyperemia and parenchymatous inflammation does not always exist
alone in the kidneys but that a congestion and inflammation of the
liver and even of the spleen is sometimes coincident.

Bureau of Obstetrics. 43

It has been argued and the theory is very generally accepted that
the albuminuria of pregnancy is the result of a mechanical interference
with the venous circulation in the abdomen just as we have albuminuria
and degeneration of the kidneys in valular lesions of the heart. The
facts that this complication of pregnancy occurs more frequently dur-
ing the latter months of gretation, when the uterus is considerably
enlarged ; is more commonly met with in primiparae whose abdominal
walls are more tense and unyielding than in women who have already
had children ; that it is almost invariably present in multiple pregnancy,
and that the albuminuria ceases at once or soon after the pregnancy is
over, have led many to affirm that this condition is due to an obstructive
hyperaemia of the kidneys consequent upon the pressure of the
enlarged uterus upon the renal veins. On the other hand the consid-
eration of the relative position of the abdominal organs tends to show
how inadmissable is this theory, and there are also other facts which
refute the arguments in its favor and show how untenable it is. In the
first place, from the very nature of its position, the right renal vein, lying
as it does in a concavity on a plane posterior to the anterior surfaces of
the bodies of the vertebrae, is protected from pressure from the dis-
tended uterus. Yet autopsies reveal the fact that both kidneys are
affected alike and that the right is as likely to be involved as is the left.
In the majority of case6 the left renal vein crosses the vertebral column
above the second lumbar vertebra. It is sometimes found in front of
the intervertebral substance between the first and second lumbar verte-
brae and occasionally lies as high as the body of the first. Now the
lower end of the uterus is concealed in the cavity of the pelvis. In order
to touch the anterior surface of the body of the second lumbar vertebra
it would have to be bent backward at a considerable angle at the prom-
intory of the sacrum. It is evident that this flexion would be pre-
vented by the round ligaments. Autopsies held on the bodies of women
who have died in the advanced stages of pregnancy show that the uterus
is held in close contact with the anterior abdominal walls by these
ligaments and between the posterior surface of the uterus and the
bodies of the lumbar vertebrae there is a triangular space with its
apex resting upon the base of the sacrum. This space is filled in by
coils of intestines, filled with gas, which act as an elastic cushion pre-
venting pressure upon the posterior abdominal wall. As stated above
changes analogous to those in the kidney are in some cases developed^in
the liver also during pregnancy. It is reasonable to suppose that both
are due to the same cause. Can the gravid uterus produce hyperaemia
of the liver from mechanical obstruction ? Let us see. Now in order

44 Bureau of Obstetrics.

to get this obstructive hyperemia of the liver there must be a damming
up of the hepatic veins. "These veins commence in the substance of
the liver in the capillary terminations of the portal veins and hepatic
artery and cou verge to form three trunks which open into the vena cava
while that vessel is situated in a fissure appropriated to it at the back of
the liver" beyond the possible reach of pressure from the enlarged
uterus. If the increase in the general pressure in the abdominal cavity
which the enlarged uterus causes, can give rise . to stasis in the renal
veins why does not this obstruction, and therefore the albuminuria
exist in cases of large ovarian tumors or in instances of extreme disten-
sion of the uterus by " hydraminos " ? The occurence of the renal dis-
ease in those pregnant women who have excessively developed pendu-
lous abdomens also argues 6trongly against the theory of mechanical
pressure. The fact that the albuminuria ceases at once or soon after the
termination of the pregnancy proves nothing more than that the preg-
nancy was the cause of the renal disease. It must be remembered that
with the emptying of the uterus by the birth of the child a great change
takes place in the distribution of the blood to the abdominal organs — a
change well sufficient to remove a hyperemia of the kidneys. The
blood of the pregnant woman is usually more watery and contains more
fibrin than normal blood, the quantity of albumen and red blood corpus-
cles is diminished while the white corpuscles are increased. Some have
thought this change of the blood causes the presence of albumen in the
urine. Ferichs places this alteration in the constitution of the blood in
pregancy by the side of that of "crasis" on which depends those cachec-
tic conditions — suppuration, ulceration, etc. — that are produced by long
continued discharges of albuminous materials, and he ascribes it to the
impoverishment of the blood consequent upon the drain of nutritive
materials required for the nutrition of the foetus. This theory is also
untenable, for the renal disease frequently attacks the most robust and
"blooming 1 ' of women whom it would be absurd to call cachectic.

Dr. Tyler Smith, of London, suggested years ago that albuminuria
may depend upon sympathetic irritation of the kidneys by the gravid
uterus similar with the irritation of the salivary glands, the mammae,
etc. Some writers have attributed the disease to the additional work
thrown upon the kidneys during pregnancy, when they are compelled
to eliminate a larger quantity of excrementitious matter. Others
have referred its origin to some deleterous substances which might be
contained in the blood during pregnancy. These substances, however,
have never been detected.

Bureau of Obstetrics. 45

Until recently, the albuminuria of pregnancy was associated and
studied in connection with eclampsia, and for a long time was looked
upon as essentially the cause of these convulsions. This was based
upon the supposition that the convulsions were due to uremic poison-
ing. Albuminuria and uraemia, however, are not identical terras, as
either condition may exist independent of the other, though it is prob-
able that the former cannot exist to any considerable extent without
more or less uraemia. In considering the relation of albuminuria to
puerperal convulsions, Fordyce Barker says : (1) " There are cases of
puerperal convulsions having all the characteristic phenomena which
attend this fearful malady in which there have been no symptoms indic-
ative of any lesion of the kidney. The most careful and repeated
examinations have failed to detect albumen or casts in the urine, either
before or after the occurrence of the convulsions." (2) " In a large
proportion of marked cases of albuminuria during pregnancy convul-
sions do not occur." (3) " In many cases where the most careful and
repeated examinations of the urine have failed to detect albumen, and
there havf been no other signs of albuminuria, convulsions have
occurred and afterwards the urine has been found loaded with
albumen."

This tends to show that the two conditions are dependent upon some
common cause instead of bearing the relation to each other of cause
and effect.

Frankenhauser, of Jena, has recently demonstrated, by careful dis-
sections, a direct connection between the nerves of the uterus and the
renal ganglia. He reasons that the nervous system and not the venous
system is the starting point of albuminuria and puerperal convulsions.
" Have we not some reason for believing that the convulsions, the
albuminuria and the lesions found in the liver are the effect of some
common cause, the exact nature of which has not been determined ?"

Therefore, as Bartels says, " there is nothing left for us but to record
the fact that parenchymatous inflammation of the kidneys, and even
the liver, may be developed during pregnancy, and to confess that we
do not know what causes them."

46 Bureau of Obstetrics.

The Effects of the albuminuria of

pregnancy.

Wm. A- Allen, M. D.,

FLU8HING, N. Y.

Albuminuria may be defined as the existence of albumen in the urine,
such albumen having found its way from the renal bloodvessels, and more
especially from the glomeruli into the tubuli uriniferi. Transient
albuminuria may come from a number of causes, among them severe
exercise, albuminous diet, irritation of the renal nerves and of a spot
on the floor of the fourth ventricle, the injection of water into the veins
and certain febrile conditions. Blood, pus and semen, when present in
the urine, responds to the tests for albumen, but thfe albuminuria which
we shall consider has its origin in the exudation of blood or albumen
through the walls of the afferent or efferent blood vessels of the kidneys
or through the glomerular epithelium, as already stated, and results from
the condition of . pregnancy. The presence of albumen in the urine
does not necessarily imply a structural change in the kidneys, at least to
the extent of Bright's diseases, nor that there coexists a condition of tox-
emia from the presence of urea creatine or creatinine, but when albu-
minuria is prominent the blood poisoning is so often intimately associated
with it, that in the consideration of the effects of albuminuria, attention
should also be called to the concomitant condition of uraemia, even if
the subject of Bright's disease be excluded. The effects of the albu-
minuria of pregnancy may in a general way be stated to be similar to
the effects of albuminuria and ureemic poisoning arising from other
causes than the puerperal state. Albuminuria during pregnancy is
most apt to occur in primiparae. There is no doubt but that when it
has once existed it is more liable to be present in, subsequent preg-
nancies, yet such is not always the case.

Should it exist during pregnancy, it is usually at a period of gesta-
tion at or subsequent to the third month. It may be slight and no
unpleasant symptoms arise from it; but should it become marked, the
more prominent symptoms are debility, nervous prostration, cephalagia,

Bureau of Obstetrics. * 47

with a sensation of cerebral hyperemia, rigors, oedema of the extrem-
ities or general anasarca, pains in the loins, dyspnoea, anaemia. There
may be dimness of sight and amaurosis. The urine is more or less
albuminous. The specific gravity, nature of the casts, (if they be
present), amount of albumen and of urea, vary is different cases. If of
a low specific gravity, a sadden and marked rise in specific gravity is
usually of moment. So far as the foetus is concerned, albuminuria and
the general condition associated with it may prevent the foetus from
attaining its normal development and tone, even if it remain in utero
for the full term. The same rule applies to the placenta. Waxy and
fatty degeneration of the latter may be present during albuminuria,
but are not dependent upon it. At the time of delivery \ ^albuminuria
and coexisting ursemia may cause convulsions. While the presence of
these spasms at this time is often owing primarily to the blood poison-
ing, still they are often developed by the hypersesthesia and the pres-
sure upon the cerebral blood vessels incident to labor, and to the irrita-
tion of the nerve centers either intracranial or in the spinal cord. This
irritation may be direct, as by the formation of a clot within some portion
of the brain, *or may be caused by the reflex action brought about by
the pressure on, and the passage of the foetus and especially of the
foetal head through the os, the vagina or the vulva. Excessive blood
pressure or the opposite condition from loss of blood, are both exciting
causes of convulsions, and so are impacted feces, gastric irritation and
the irritation caused by drastic cathartics. The mere pressure of the
foetus in utero, the distension of the uterus by the liquor amnii, the
operation of turning, or that of delivery by the forceps, the extraction
of the placenta, either with or without the introduction of the hand
within the uterus, may bring on convulsions. These conditions may
produce spasms acting independently of uraemia, but when it is present,
even in a moderate degree they are much more apt to lead on to con-
vulsions than when existing without it.

Urflemic convulsions are apt to be ushered in by headache. There
is pain and a feeling of weight in the vertex, forehead, orbits or back
of the neck. Vomiting is often an early symptom. Daring pregnancy
vomiting, especially where there is a clean tongue, should be regarded
with suspicion. The headache is usually followed by drowsiness and
twitchings of the voluntary muscles of an epileptic type. There may
be a single paroxysm or a succession of paroxysms. The spasms are
apt to be followed by coma. During the period of remission between
the convulsions, we have stertorous breathing, pale face, dilated pupils,
drowsiness, with a semi comatose state, from which the patient can

48 Bureau of Obstetrics.

usually be partially roused. There are defects of sight and hearing,
and diarrhoea may be present. So far as vision is concerned, the blind-
ness may be either temporary or permanent. Objects frequently appear
as though veiled in mist. The opthalmoscope fails to reveal any change
in the eye excepting that the retinal vessels are distended with blood.
They are not ruptured, as in retinitis apoplectica. Uraemic deafness is
not as frequent as are the defects of vision. It should be stated that
uremic coma may come on suddenly and without preliminary symp-
toms, and resemble an attack of apoplexy. The condition of the eye
and the accompanying symptoms will serve in making a diagnosis. It
was stated, when considering the condition of the foetus and that of the
Placenta during gestation, that the foetus might not be properly nour-
ished and might be wanting at least in tone. The result is, that at the
time of birth the child is not possessed of proper vis vita. It is not
perhaps a normal child in other ways than the matter of vigor, con-
sequently is not able to endure the pressure incident to delivery and we
have a still-birth. It is a question whether or not many of the hydro-
cephalic heads found at the time of labor do not owe their origin to the
uraemia and dropsy resulting from the albuminuria of pnegnancy.

The same idea is applicable to the state of the placenta and to that
of the umbilical cord at delivery. Is not the easy tearing of the cord and
placenta sometimes due to albuminuria ? Is the waxy and the fatty
degeneration of the placenta in any way dependent upon it ?

Should premature labor be brought about, or should gestation go on
to full term, after delivery the recovery is sometimes slow even under
proper treatment. Uraemic convulsions may occur at this period, even
if the patient has escaped them to this time. Albuminuria is sometimes
due to a constitutional tendency to renal difficulties. Such tendencies
may be awakened by the irritation and congestion of the kidneys caused
by the mere presence of the foetus in utero, or from the pressure of
the gravid yterus upon the renal vessels. Albuminuria does not
necessarily imply structural changes in the kidneys, but the greater the
quantity of albumen the greater the probability of renal disease. If
the albuminuria has been slight and there have been no structural
changes, under proper treatment the oedema, headache and dyspnoea
are relieved, the blood gradually resumes its normal condition and the
debility, nervous prostrations, anaemia and albumen disappear. If
the attack has been marked and persistent during recovery, the symp-
toms are relieved gradually, the urine becomes normal in quantity and
color, the casts and albumen become less, and finally we have proper
urine. There is a general law which applies to blood distribution,

Bureau of Obstetrics. 49

velocity and pressure in all parts of the organism, which has not in the
past been sufficiently emphasized. It is that there is a normal — a
physiological — blood supply, pressing and " waste," varying according
to the part under consideration, and that if either of these factors be
persistently augmented or diminished, a pathological cell action results,
function and repair may be stopped and degeneration of tissue result.
Congestion of the kidneys may be active or passive. In the former
instance an undue amount of blood is sent to the kidneys. As a con-
sequence of such persistent action, not only is the physiological status,
so far as the secretion of the urine is concerned, interfered with, but
the arteries are distended, the blood filters through their walls, both
the afferent and efferent vessels, the glomeruli, malpighian bodies and
tubuli uriniferi are filled with broken down blood globules, epithelium
and debris ; the kidneys are la^ge and soft, and a longitudinal section
shows them to be of dark chocolate color, filled with blood and having
many hemorrhagic spots. A change of tissue follows and we have one
of the forms of Bright's disease as a result. Total suppression of renal
circulation produces gangrene of its tissues.

The passive congestion does not come from the increased supply of
arterial blood, but is owing to the pressure of the gravid uterus upon
the renal veins. The escape of the blood from the kidneys is thus
impeded, the walls of the veins near the point of infarct are distended
by the pressure behind, the continued and extended pressure causes the
distension to extend further on, until the walls of the veins of the kid-
ney are more or less involved. As a result, we have, as in the preced-
ing case, a filtering of the blood or its albumen through the distended
vascular walls. In this case, however, the efferent vessels are more
especially involved. If the obstruction to the venous circulation be not
extensive and not persistent, we find albumen in the urine, or we
may have albumen, blood globules and casts (fibroid cylinders).

If the pressure be marked and long continued, the renal blood vessels,
malpighian bodies and the tubules become filled with -blood globules,
epithelium and fibrinous casts. There is uraemic poisoning. The kid-
neys are engorged with blood, are enlarged, and of a brownish or
purplish hue. Hemorrhages takes place in both the cortical and the
medullary portions. Fatty degeneration and decay may result if the
venous stasis continue for sometime.

It will thus be seen that the condition of the woman who has had
albuminuria during pregnancy, after her delivery, is a variable one. If
the albuminuria has been slight and there have been no structural
changes so far as the kidneys are concerned, the effects are compara-

BUBEAU OF OBSTETRICS.

little moment, if however, there has been a large quantity of
and the changes in the renal tissues which usually accompany
mdition have been present, the effects, I might say the prog-
neh a condition is to be governed almost entirely by the degree
ature of the degeneration of the tissues of the kidneys. To
2ast, in many of these latter cases, complete recovery is
doubtful.

THERAPEUTICS OF THE ALBUMINURIA OF
PREGNANCY.

By Geokge W. Winterbdrn, M. D.

■e of this complication of pregnacy is often difficult, and in
i seems impossible. Nevertheless it is rare that the properly
imedy fails to benefit, to some degree, and in many cases all
nal symptoms disappear, including the albuminous quality of

bed has been found a very important factor in the treat-
many cases, where the proportion of albumen is as high as
•or cent., the continuous recumbent position, without other
the surroundings of the patient, or any change in her diet,
)d the percentage of albumen nearly one-half. Mental rest
rtant as physical, and unless the patient can be kept from
. undue nervous excitement, no very decided results can be
Tom the medicinal treatment. The patient's skin should be
, and thus as much of the depuratory work of the system
led through it as possible. This cleanliness may be secured
ily sponging with alkalized warm water. I have sent sev-
its to the Turkish bath with manifest advantage to them-
; this measure is impractical in a vast majority of cases, and
except where the attendants are known to be carefnl and

[ should be largely liquid, and if the patient can be restricted
liet, all the better. The patient may be encouraged to drink
^lysmicorBethesda water. If these do no other good, they

Bureau of Obstetrics. 51

at least flush the tubules of the kidney and wash out obstructions.
Large meals are an objection, and while the patient need not be put on
what is styled a low diet, it is better to take food in small qnantities at
more frequent intervals. Light-weight flannels should be worn next
to the skin, and changed night and morning ; this is very important.
Exposure to inclement weather, draughts, etc., must be avoided, as a
suppression of the natural exhalation from the skin is sure to be fol-
lowed by an increase in the percentage of albumen in the urine.

The selection of the remedy homoeopathic to the case is not easy.
The symptom " albumen in the urine " is of little service, as most of
the drugs which have been used to cure this condition have never been
proven to possess this characteristic in their pathogenesy, and many
remedies which might be called for in albuminuria from other causes
would not be demanded here. We should hardly look to Crotalus,
Aurum, Nitric or Benzoic acid, or to Phosphorus in the albuminuria
of pregnancy, although these have all been found of the greatest clini-
cal service in cases where the urine was albuminous.

Among the remedies to which we may look for help in these cases
are :

Kalmia latifolia. Hering's proving contains only the symptom:
Frequent micturation- of large quantities of yellow urine. But clini-
cal experience shows it to be an admirable remedy in albuminuria. In
women of a rheumatic diathesis, or with functional disturbance of the
heart, Kalmia would be a possible remedy. It is regrettable that we
have no clear indications for this remedy, but the relief of the head
symptoms on lying down is characteristic, as is also a sense of weakness
and weariness in all the muscles, with irregular pains ( pains come on
at indefinite intervals, and change from place to place). The power
of Kalmia, in many cases, is not doubtful, and I have seen it reduce
the albumen in the urine in a few days from 20 per cent, to an almost
inappreciable amount; and in all cases, unless /some other remedy
should seem to be particularly indicated by the concomitant symptoms,
I should tr} r Kalmia first.

Another very hopeful remedy in these cases is :

Helonias. The patient is apt to be melancholic and irritable. The
gastric functions are disturbed, there is numbness of the lower ex-
tremities, and burning pain in the small of the back as if the kidneys
were two little bags of hot water, but the patient isn't half as sick as
she thinks she is. If with albuminuria there is this tendency to
magnify her ailments, a tendency which passes away if her interest
can be aroused in subjects ulterior to herself, Helonias is likely to ini-

Bureau of Obstetrics.

uality of the urine, as well as remove the morbid condition
Helonias is a valuable remedy in the treatment of diseases
; origin.

nite often the homoeopathic remedy because of the tendency
spsy. It will be demanded when there is oedema of the
of the hands, of the face, or of other parts. Very great
the neck of the bladder, with frequent, painful urination
characteristic. So is drowsiness without ability to sleep on
a peculiar nervous restlessness. Apis is said to be an un-
' in cases liable to abortion.

bonioum is frequently suitable in anaemic cases with a very
There is generally a very severe pain in the back, and,
local cedemte. There is intense thirst (contra Apis.) i

medies to be consulted are in the order of probably adapt-
pocynum can., Terebinthina, Cantharis, Arsenicum, Mer-
and Hepar sulph., though in every case the remedy will
elected, not for the albuminuria, bnt for the general symp-

ERPLEXING CASE OF PARTURITION.

R. C. Moffat, M. D.

BROOKLYN, N. Y.

reporting a perplexing case of parturition just as the inei-
: birth presented themselves. My object is to show that
ion of unusual phenomena is not as easy as our text-books,
tly our lecturers state them to be.

myself from the imputation of inexperience, let me state
actice is of forty years duration, and covers a personal
y for over 1,000 births.

— , aet. 33, in perfect health and physique, went through
rturition successfully, and from all customary modes of
expected her second on the 9th of February last She had
iow " a week or ten days before that date, and except one
irrences of the same sign, nothing occurred for a month.

Bureau of Obstetrics 53

On the J Oth oi March I was asked to make an examination. The
cervix was nearly absorbed ; the os, patulous ; and within I recognized
a sof t body that suggested placenta prsevia. My report to the hus-
band was simply, " she has mistaken her reckoning — she will want me
in a day or two," but having the show in mind, my expectation was —
a lively time from a placenta over the mouth of the womb — probably*

The next day I was summoned. She had been four hours in easy
labor when I arrived at her bedside and made examination. The os
was well opened, and there was no difficulty in recognizing within the
bag of waters — a foot ! So of course I had a footling case, and my
only difficulty would be in the safe delivery of the head. But was it
afoot? Let me examine again. Yes, there were the proper length
and shape of a foot, handled from below. It was broad and flat at one
end and narrower and harder at the other. I could not indeed deter,
mine the toes, nor as yet the ankle. However the waters had not yet
broken and I must wait.

There was no hemorrhage, so the placenta praevia passed out of my
mind. The os enlarged and the waters broke. Examination renewed.

Now, there projected a soft pulpy mass, firm during a pain, less so
in the interval, that suggested the nates, or at least one side of them.
Where was the foot ? Gone ! Nothing like a foot there now, and the
examination was extended.

It seemed marvelously like a breech ; I could make out one of the
nates, what would pass for the sulcus, and the nates of the other side,
but I found also a portion of covered bone, hard and sharp, that might
(and should) be the tuberosity of the ischium. But the bone was long
and sharp, a curved edge, not a blunt point, and an edge that extended
further than I could reach. That did not answer to the blunt tuber of
the ischium ! What is there in the body of the foetus like it? Not
the ramus of the ischium ? Not the crest of the ilium ? No, there
was nothing. I examined again, both in the intervals and during the
pains, and could only find what it was not It was not a cheek and
shoulder, nor a flexed thigh and calf. It must be the nates, for I could
feel the bottom of the sulcus, and in the crowded condition of the
parts, this best answered the indications. I could wait, however, for
the condition of the patient was excellent.

And in waiting new perplexities presented. As the foetus descended
I could extend the examination, and I found just beyond the nates and
the bony edge, what, examined by itself, seemed to be an ear. But
was it not a testicle ? Hardly, it was too flat, it felt like the helix and
anthelix, and by crowding the touch, something like the junction of

Bureau of Obstetrics.

ie head. But was it a head ? Not like anx other head I
t. Now a testicle, whether hard or soft, ought to be round
) — this was thick and flat. Somehow it was an ear and no
I I rested in that conclusion, especially as extending my
ind another just like it — and two testicles do not happen
in proximity with one breech. Here again I must wait,
u'le I was able to extend my finger beyond the ear, or tes-
ter it was, and to reach the groin, if it was the groin, over
;er. Making a blunt hook of my finger, I made steady
h each pain and held what I got in the interval.
'elous how intelligent the educated finger is in explorations
sight ! Whether it be in the throat, the vagina, the rectum,
How it supplements the eye ! Here, by feeling side-
be finger, I recognized the thigh on one side and the abdo-
foetus on the other, and I had only to wait and make trac-
birth proceeded steadily and I received in my hands— an
tale child !

easy now ; my " nates " was the engorged and protruded
in situ by its enveloping membranes. I recognized my

was a large mass, perhaps a clot of blood lying in the

sinus ; my " testicles " were veritable ears, and my "groin"

the child's neck.

NATIONS OF PARTURITION-PELVIC DYS-
3CIA AND METHODS OF DELIVERY.

By H. J. Piekkok, M. I).

BROOKLYN, N. Y.

ind Tarnier divide dystocia (with respect to its cause) into

e rendered difficult, dangerous or impossible by an exces
3f the expulsive forces.

e rendered difficult, dangerous or impossible by obstacles to
>n of the foetus.

Bureau of Obstetrics. 55

3. Those complicated by accidents liable to endanger the life or
health of the mother and child.

Of these causes I shall speak mainly with respect to the second, in-
asmuch as the subject of this paper is pelvic dystocia.

Pelvic Dystocia. — Labor rendered difficult, dangerous or impossible
from some distortion of the pelvis.

You all know what is given in the text books as the average meas-
urements of a well formed female pelvis; but, judging from the
various authorities, it is by no means settled how much variation from
these generally accepted figures is necessary to constitute a malformed
pelvis.

Anywhere from two lines to Cazeaux's definition, which is "any
pelvis which from excessive size or narrowness is capable of producing
notable difficulties in the exercise of the puerperal function," — being
given as distorted.

It seems to me that Cazeaux's definition is the moBt rational and,
adopting this definition, 1 also adopt his classification which divides
the subject into two heads :

Distortion by excess of amplitude.

Distortion by excess of retraction.

The first is important only as exposing the woman to all the dangers
of a too rapid labor by allowing the voluntary muscles to act before the
dilitation of the os is accomplished and the bony walls not being close
enough to support the womb, the whole mass is brought down ; or the
lack of obstruction at the straits allows of the expulsion of the child
before the os is dilated and produces a severe laceration. The condi-
tion is one easily managed as far as the delivery is concerned if the
fact of there being too large a pelvis is known in time.

The second, however, is not this simple state of affairs, for the
existence of a retracted pelvis is one of the most serious conditions met
with in the course of a labor.

There are two forms of this :

The simple contracted pelvis without curvature or malformation of
the bones (absolute contraction of Velpeau) and the contracted pelvis
by the curvature and malformation of the bones (relative contraction
of Yelpeau).

In respect to the first there is little to be said. It is a condition
that has only been recently admitted as a separate variety; in the
earlier classical works it is not mentioned at all, as at the time they
were written, it was not supposed that a pelvis could be relatively small
in all directions without some bony malformation.

56 Bureau of Obstetrics.

It is a condition that is impossible of diagnosis except by local
exploration.

The second relative contraction of Valpeau, is the common form
of pelvic distortion, to which there are in general four assignable
causes.

1. Deformation from rachitis.

2. Deformation from osteomalacia.

3. The oblique oval pelvis.

4. Deformation consecutive to a previous deformity of some other
part of the skeleton.

In considering these causes separately (and in passing it might be
as well to say that the cause of the absolute contraction seems to be
simply a freak of nature, the same as a disproportionately large head
or an exceptionally small limb,) it is found that the first, " rachitis, "
deforms the pelvis by altering the shape of the bones and by arrest-
ing their development. The most important alteration in a rachitic
pelvis is: The antero-posterior diameter of the superior strait is
always shortened and usually the oblique is the same. Transverse less
frequently — sometimes normal — or even lengthened.

The sacrum is less curved. The diameters of the inferior strait
are usually normal, except in a small proportion of cases, where they are
lengthened.

Deformity by Osteomalacia. — This, like rachitis, by softening the
bones diminishes their power of resistance, but it differs from the first
in that it appears only in adults and not in infancy and often occurs
after a woman has had one or two children.

The softening of the bones in osteomalacia is generally greater
than in rachitis, hence the pelvis is often much more deformed.

The deformity is usually the contraction of the lateral parts and a
projection of the pubic symphysis. The iliac fossae are crowded
inwards. The sacrum is much more curved. The inferior strait more
deformed than the superior 6trait, all its diameters being altered — viz :
shortened. But more especially is there a considerable approximation
of the tuberosities of the ischia and of the ischia-pubic rami.

According to Dr. Harris osteo-malacia is rarely met with in this
country, it having been observed in the United States only in a few
isolated cases.

The Oblique Oval Pelvis. — This variety was first described by M.
Nseg^le as the oblique contraction. Its principal characteristics are a
perfect fusion of the sacrum with one of the iliac bones.

Displacement of sacrum to anchylosed side.

BlJBEAtT OF Ob8TETRIC8. 57

Displacement of symphysis to healthy side.

Malformations dependent upon a previous deformity of another part
of the skeleton.

Those that affect the form and position of the pelvis most are :
Deviations of the vertebral column, congenital and non-congenital
luxations of the femur, lesions of the inferior extremity, contu-
sions of the dorsal region during childhood.

Of course the effect of these conditions on parturition is known and
apparent to all — inasmuch as the narrowing of the canals and the
placing of bony obstacles in its way can but hinder the expulsion of
the child ; though it is to be remembered that these effects are not
absolute, but merely apply to a majority of the cases, inasmuch as so
many factors influence the mechanism of labor. For example, where
a pelvis is very much contracted we may be fortunate enough to find
a very small child or a particularly mobile head, or a symphysis that
yields to a remarkable degree, thus allowing of a spontaneous delivery.
However, as these conditions are not discoverable until the child is
born, it still leaves the necessity of being prepared with some course
of treatment independent of the help that may be afforded by nature.

The generally accepted scale of measurements (as all obstetricians
give about the same) which will determine what class of procedure it
will be necessary to adopt is :

1. A pelvis which at its contracted part has an opening of 3£
inches — all diameters.

In this class, labor is apt to be slow but a spontaneous delivery may
be reasonably expected.

2. Where one or more diameters have an opening of 3£ inches as
a maximum and 2£ as a minimum.

In pelvis of this minimum measurement (2^ inches at contracted
part) a spontaneous expulsion of the foetus is barely possible. In a
large majority of the cases, outside aid is required, unless the head is
preternaturally small, or is reducible to a large extent or unless the
bones are softened by putrifaction or lack of development.

3. Where the narrowest point is under 2£ inches.

This condition almost invariably precludes, so rare has been the
exception, a natural delivery, (there being, so far as I can learn, but two
substantiated cases on record where delivery was successfully accom-
plished and the pelvis measured under this limit. In these the pelvis
was 2i inches at its narrowed point) and there is no alternative but to

;r< ..

|j|y. 5ft »' Bureau of Obstetrics.

| '■ * '}' either enlarge the passage, diminish the bulk of, or provide a new place
rV of exit for the child.

;<:.*

ffiiff' The weans of diagnosis of these hindrances to a successful labor are
jfc substantially as follows :

O0$rY. Rational signs, or as I understand it, subjective symptoms : First,

a most minute inquiry into the early history of the patient, particu-
larly as to all the accidents which befell her during infancy, the age at
which she first began to walk, whether standing in the erect position
was possible or easy in early years, or after having walked well she
i was afterwards afflicted with any weakness in the lower extremities.
*?&",: If there is any present curvature of either the spine or limbfe, or of
fy both, and if there is such curvature the period at which it appeared,

a ;^ • and if the curvature is of both the spine and limbs, whether that of
^ ' the lower extremity preceded or followed that of the spine ?

'. * ••

If she limps ascertain carefully the cause, see if it proceeds from a
y shortening of the limb, or atrophy of one limb, or whether it is due

to a flattening of the anterolateral walls of the pelvis, or an old or
i\ recent affection of the ilio-femoral articulation, or a spontaneous or

> congenital luxation followed by the permanent displacement of the

head of the femur, or whether upon an old and imperfectly consoli-
dated fracture.

-*:-

Inasmuch as the two principal deformities of the skeleton are
from rachitis or spinal curvature, the above minute history and
examination is decidedly important, because in the first the pelvis is
almost certain to be deformed, while in the latter it may be perfectly
normal. In rachitis the deformity, as you know, is especially in the
long bones, and the short stature usually seen is due to the arrested
development and curvature of the long bones, and the pelvis descends
with them as well as partaking in the general osseous trouble.

While in the case of spinal curvature the long bones being normal
as to development the pelvis is held in its natural position ; the stunted
appearance of the woman being due to the folding together of the
spinal column.

Again, this history of the early years or months is important because
modern pathological research has shown that rachitis, properly so
called, is a disease almost exclusively confined to infancy, though it is
seldom observed in the infant at term, usually beginning at about the
eighteenth or twentieth month and rare after puberty.

r ;

Bureau of Obstetrics. '5d

A prominent Parisian authority says that in 386 cases, of which he
has the history, the invasion was :

Before birth 3 cases.

First year 98 "

Second year 176 "

Third year 35 "

Fourth year 19 "

Fifth year 50 •<

Sixth to twelfth year 5 "

m Total 386 cases.

From these and more, reported by Bouvier, Ruff and others, it seems
to be settled that deformities occuring in infancy are nearly always of
a rickety nature, and to quote from M. Jules Guerin : " We may
exclude rachitis in all varieties of softening that take place in adult
bones, and all deformities occurring exclusively in young girls at or
about puberty." And he goes on to say "if the cause of the
deformity can be traced to a period of life before puberty, and
especially if the deformity has made its appearance from below
upwards it is rachitis, and the almost certain probability is a deformed
pelvis." The spread of the deformity from below upwards is a symp-
tom that is concurred in by all the leading orthopedists of the Old
World as being indicative of rachitis. This same authority affirms
that the deformity is due to osteomalacia if the following conditions
have been exhibited : In all cases where the deformity occurs after
the adult period of life had been reached, and especially if it followed
one or two successful confinements, and also if the patient has. had
symptoms of acute softening.

The next are the sensible signs, that is mensuration of the pelvis.
This is both external and internal (external and internal pelvimetry).

The only thing to be said in respect to it is that the following are
the average measurements of a well formed pelvis :

1. From anterior inferior spinous process of one ilium to same
point on the opposite side, 8£ inches.

2. From anterior superior spinous process of one side to same
point on the other, 9£ inches.

3. From middle of iliac crest on one side to same point opposite,
10£ inches.

4. From the middle of iliac crest to tuber-ischii, 7£ inches.

The superior strait divides this distance into two equal parts, whence
the lateral portions of the greater or lesser pelvis are each 3J inches.

•i

X«

1 1»:'-

60 Bureau of Obstetrics.

5. From the anterior superior part of the symphysis pubis to the
apex of the first spinous process of the sacrum, 7£ inches.

From which 2£ inches are to be deducted for the thickness of the
base of the sacrum and i inch for that of the symphysis, leaving for
the sacro-pubic interval, 4J inches.

6. From the tuber-ischii of one side to the posterior superior spin-
ous process of the opposite ilium in an ordinary pelvis is, 7 inches.

7. From anterior superior spine on one side to posterior superior
spine on the other side — mean 8J inches.

8. From spinous process of last lumbar vertebra to the anterior
superior iliac spine of either side, 7 inches.

9. From trochanter major of one side to the posterior superior
spinous process of the opposite side, 9 inches.

10. From the middle of the lower border of the symphysis pubis
to the posterior superior spinous process on either side, 6f inches.

The above are the measurements. They are good if you can get
them, but I find that it is considered no easy task to make these exact
measurements. There have been a number of pelvimeters invented,
but they are all unsatisfactory, owing to the extreme difficulty of using
them and their liability to mislead. The ordinary digital examination
is the surest and safest plan.

In a digital examination the anterior, posterior and lateral walls of
the pelvis are comparatively easy of examination, and this is very fre-
quently sufficient.

Indications for Treatment : The procedure to be followed when
the pelvis measures at its most contracted part 3} inches. First, vertex
presentation — spontaneous delivery possible. It is said to wait about
eight hours after the membranes have given way and the os is fully
dilated (unless some accident dangerous to mother or child occurs, or
the feebleness of the pains indicate different,) and then apply forceps.
Pelvic presentation,. — Make traction and apply the forceps some-
what earlier. Face. — Convert to vertex and apply forceps at once.
Trunk. — Treatment differs according to stage of labor. If the con-
traction is discovered before the membranes are ruptured (or very
shortly after) and the foetus is very movable, the conversion of the
presentation of the shoulder to one of the vertex should be made
and then leave the rest to the expulsive forces of nature, but after
the waters are discharged the contraction of the womb renders the
introduction of the hand and cephalic version difficult, and it is
better to turn by the feet.

Of course the certainty of the child's being dead would alter this,

BUJREAU OF OB8TETRICS. 61

as pelvic version would be easier for the mother. Cephalic version
being recommended on account of its being safer for the child ;
second degree of contraction — 3f greatest, 2J shortest.

If the foetus dies before or during labor and the uterine contractions
are unequal to the task of expulsion the dangers of delay are so great
that it is best to perform embryotomy and the application of the
ordinary or embryotomy forceps.

If, however, the membranes have broken and the water partially or
wholly evacuated, and the uterine contractions are exerted on the
child's body alone, and repeated endeavors have been made to extricate
the child without success, it is deemed by some to be admissible to
attempt pelvic version, and thus try, if there is any reason to believe
the child is still alive, to deliver it still breathing. However, thte
majority of the writers advise craniotomy.

Pelvis under 2£ inches. There have been two cases reported by a
French obstetrician in which delivery was safely accomplished where
the longest measurement was 2J inches. From the fact, however, that
there has been but these two isolated instances reported it may be as
well to leave them out of consideration as having any bearing on the
general rule, which is that delivery unaided is practically impossible,
and the choice where the pelvis is under 2£ inches being between
embryotomy — Cesarean section-— Porro's or Muller's or Veit's modi-
fication or laparo-elytrotomy.

If the child is dead embryotomy is to be tried first, or if the child
is still alive and it is decided that it is advisable to risk the mother's
life to the the extent of an abdominal section it is to be decided which
of the others shall be attempted.

The indications for Caesarean section are crainotomy and version
unsuccessful — pelvic contraction — solid tumors encroaching upon the
pelvic space. Advanced carcinomatous degeneration of the cervix.
If the mother is moribund and the child known to be alive and the
rapid delivery by the natural passages is impossible. Or it may be
undertaken at the mother's request if otherwise delivery cannot be
accomplished without the sacrifice of the child.

Lusk says, in his chapter on this subject, that the great objection to
Csesarean section is that the results are entirely dependent on the
amount of uterine contraction subsequent to the operation. He says:
When the operation is performed early in labor and the pains are well
established and yet the patient's strength is not exhausted and the
sutures are introduced, art has done all it can, and then if there is
imperfect contraction of the uterus or a cutting out of the sutures, it

•:v- ' • *♦

•. *

\r''

f r 62 Bureau of Obstetrics.

{f : .V leaves an open communication between the uterus and the abdominal

~V cavities ; and as the uterine section itself is apt to excite a considerable

X : ] degree of catarrhal endometritis, and as the admission of air into the

uterus furnishes the condition for the decomposing of the lochia, it
» folio ws that the patient is always exposed to the dangers arising from

penetration of septic materials into the peritoneal 6ac. One of the
most important advantages claimed for laparo-elytrotomy is that the
incision is made into the walls of the abdomen in a line of Pouparts
ligament, lifting the peritoneum and dissecting down to the vagina,
dividing it (the vagina) transversly, and then having reached the
cervix extracting the child through the cervix and accomplishing deliv-
ery through this artificially-made opening, and thus avoid entering the
peritoneum or wounding the uterus. At this point is one of the chief
objections to this operation, because, in order to bring the child through
the cervicel canal, labor must have actually begun, and in fact be
pretty well advanced, for the reason that the os uteri mu6t be dilated
to a considerable extent to accomplish it. To quote again from Dr.
Luek's work on Obstetrics, " The operation should not be undertaken
unless it is certain that the dilatability of the cervix is such as to allow
delivery by forceps or version, after the artificial canal is formed, to be
. accomplished with ease and certainty." Statistics of the five opera-
tions, Caesarean section, Porro's, Muller's and Veit's modifications and
gastro-elytrotomy show an advantage for the latter three as against the
first, Muller's modifications having a smaller percentage of deaths than
Porro's.

Dr. Harris giving the following : Caesarean section — general mor.
tality, sixty per cent., and in Great Britain eighty-one per cent.

Up to this time, 1886, Veit's operation shows a general mortality of
nearly seventy-one and a half per cent.

Up to March, 1885, there have been forty-two operations by the Mnl-
ler modification, with twenty-one mothers and thirty-one children
saved.

By the original Porro method, one hundred and nine operations,
saving forty-six mothers and eighty-five children.

The results so far with Thomas' operation give it a better record
than any of these, but as this operation is so new and the number of
times it has been performed so few, in comparison with the others, it
is unsafe to base any positive judgment upon it, for the next few
operations might either still further increase its good record or place
it below even Caesarean section. There have been four modifications
of Caesarean section proposed, (all originating in Germany) which

ftrr

Bureau of Obstetrics. 63

endeavor to lessen the mortality, but the success of these h%3 not been
very great.

Dr. H. J. Garrigues, in quite a long and exhaustive article in the
American Journal of Obstetrics, compares gastro-elytrotomy with
Aophora-hysterectomy and arrives at the following conclusions :

1st. That Dr. Thomas' method of gastro-elytrotomy has been per-
formed eight times (this article was written in 1883, since which there
have been, I think, three operations,) saving one half of the mothers
and all the children except two that had died long before the operation
was performed. Thus the percentage of recoveries was as good as in
the best of the other operations.

2d. The operation may be performed with many antiseptic precau-
tions.

This is given in answer to that which has been more of a fear than
actual objection to this operation, namely, the impossibility of operat-
ing with strict Li6terism. Though this is true and antiseptic surgery
cannot be carried out completely, yet many antiseptic precautions may
be taken, by the careful disinfecting of the patient and all the partici-
pants in the operation, as well as all the instruments, and a free use of
Carbolic injections and dressings.

3d. Porro's operation has given less good results and Muller's no bet-
ter than gastro-elytrotomy.

4th. The dangers, especially as regards hemorrhage — peritonitis and
septicemia are greater in Porro's and Muller's operations.

Hemorrhage would be less in Thoma?' operation, for the reason that
the uterus is unharmed in this case, while in the old operation the
incision was made into the uterus, and besides the necessary hemor-
rhage, there was the liability of entering the uterine sinuses. Porro
endeavored to lessen the liability to hemorrhage and also to septicemia,
by, after emptying the uterus of its contents, ligating it at the neck and
amputating it just above the internal os, then bringing the stump out
and fixing it at the lower angle of the external wound, thus making
the treatment of the 6tump extra-peritoneal. Muller thought to
improve it by bringing the uterus out of the abdomen before opening
it (the uterus) and evacuating its contents. Prof. Veit's operation was
the same, except the treatment of the stump was intra-peritoneal.

In respect to peritonitis the danger would be less, because the per-
itoneum is unharmed. The diminished liability to septicemia has
already been spoken of.

5th. The intra-peritoneal treatment of the stump in Veit's modifica-
tion carried out in five cases has four times resulted in death.

Iff.* / ^ ',. A. ; »•

■Ms , '•

.«.',/

64 Bureau ofr Obstetrics.

6th. One advantage of the Porro-Muller operation is the possibility
of operating before the commencement of labor.

It is true that oophorohysterectomy can be performed before the
dilitation of the os has begun, and thus the operator may choose his
own or the best time, do it at leisure, and the patient will not have lost
strength by efforts at delivery through the natural passages.

Though this is in favor of either Cesarean section or its modifica-
tions, it must be remembered that it is quite seldom that the case is
brought to the notice of the surgeon very long before delivery begins.

7th. Gastro-elytrotomy is less repulsive to the mind of the patient, less
difficult of execution, and can be performed with less assistance than
the Porro-Muller or Veit's operation.

It is said that gastro-elytrotomy can be performed by the ^operator
and one assistant, the latter to give the anaesthetic.

8th. It does not sterilize the woman.

Most all of those who have written upon the subject agreeing that
the operation can be performed two or even three times upon the same
woman.

9th. In country practice the old-fashioned operation of Caesarean
section will in most cases be preferable to all its substitutes.

This because it requires so little assistance and can be done with
any ordinary cutting instrument. There being records of cases being
operated on with a common razor.

10th. Thomas' operation can be performed on the left side as well as
the right.

11th. The ureter stays below the incision and is out of danger.

12th. All those who have performed gastro-elytrotomy on the living
subject or on the cadaver recommend it.

There are three points I should have mentioned when speaking of
Dr. Garrigues' fourth conclusion, viz : the difference in danger between
the two forms of operating. They are the danger of septic-peritonitis
and septicaemia when the foetus is dead and the liquor amnii fetid,
when of course the danger of the above would be much greater with
the operations that open the uterus, and the dangers of shock and
exhaustion. The danger of the former (shock) is greater in the older
operations, but the danger from exhaustion from the suppuration is
decidedly more in Thomas' operation ; at the same time there have been
no deaths from this cause, either because the patient has not lived to
reach that stage, or the careful attention to cleansing the parts and a
free use of Carbolic acid has prevented any untoward result.

» r

Bureau of Obstetrics. 65

Most all of what I have said has a favorable bearing towards the
operation of Dr. Thomas.

The following are some of the counter indications to it :

One. — The impaction of the head in the pelvis.

Two. — Pressure of a large tumor in the vagina.

Three. — An obstruction in the womb itself.

Four. — Atresia or coarctation of the vagina.

Five. — The pressure of a tumor starting from the anterior wall of
the pelvis and pushing the vagina back towards the sacrum.

Six. — The general condition of the patient will sometimes contra-
indicate it. That is where the system is in such a bad condition
that it is certain she cannot stand the loss caused by the extensive sup-
puration consequent on gastro-elytrotomy.

There is one other objection, which, however, is not shared in by all
the more prominent accoucheurs who have written on the subject :
That is the difficulty of bringing the cervix above the brim of the
pubes to enable the operator to extract the child with the forceps or to
perform version.

So far I have said nothing with respect to the indications of prema-
ture labor. Of course if a woman becomes pregnant and it is discov-
ered that she has a contracted pelvis, the question of bringing on labor
before time is to be decided. Cazeaux and Tarnier recommend the
induction of premature labor at the seventh month of gestation in all
cases where the shortest diameter of the pelvis is three and three-
fourths, beyond this, as a rule, unsatisfactory.

It was my intention to have gathered the opinions of the more cel-
ebrated accoucheurs on the operation of gastro-elytrotomy, but the
only decided remarks I can find are by Dr. Thomas Whiteside Hime,
of Sheffield, England, who says : " Considering the easy nature of the
operation — the certainty of saving the child and the strong probability
of saving the mother, it is a question how far craniotomy will again be
justifiable, and whether Caesarean section should not drop into obliv-
ion." And Dr. Edis, of London, says : " The operation of laparo-
elytrotomy will supercede that of Cesarean section, and also in many
instances that of cephalotripsy."

Most of the other obstetricians of note practically unite in saying,
wait and see what results the future will bring forth.

REPORT

OF THE

BUREAU OF GYNAECOLOGY.

Drs. Walter Y. Cowl, Chairman, - - New York City.

Henry Minton, Brooklyn.

C. S. Macy, New York Citv.

Amelia H. Wright, .... New York City.

George Allen, .... Waterville.

THE SUSPENSION OF THE CLOTHING.

By W. Y. Cowl, M. D.

BROOKLYN, N. Y.

At the meeting of this Society in Brooklyn in 1881, it was my priv-
ilege to read a contribution upon " Tight Lacing," and the various
disorders that may result therefrom.

The number, the variety and the severity of the affections which
such a constriction of the waist with compression of theabdomen and
lower chest, either favor or determine, was found to be considerable.

The compression that the term u Tight Lacing " implies, was viewed
as restrictive of both the motions of the body and the movements of
respiration and of peristalsis. This restriction is evident to anyone who
has had an abdominal bandage tightly applied, and its effects upon the
performance and health of the parte compressed is to be readily
inferred.

It is apparent that while constriction of the waist hinders the flow
of blood in the veins of the lower half of the body towards the heart,
and begets or favors disorders of the rectum and other pelvic organs,
compression of the abdomen and freer part of the chest prevents the

♦Read by title.

Bureau of Gynecology. 67

proper expansion of the lungs — both laterally and vertically — upon
which the purity of the blood depends, checks the corresponding
motion of the abdominal organs, which nominally, without doubt, aid
their slow circulation, especially in the liver, and obviously interferes
with the comparatively weak and involuntary contractions of the
stomach and intestines upon which digestion depends.

An idea of the nature and importance of these movements is to be
gathered from observation of an animal, such as a rabbit, which has a
lax abdomen, and is mainly dependent upon diaphragmatic respiration.
The abdominal wall, especially at the epigastrium, is seen to rise with
each inspiration and sink again upon expiration, while waves of peris-
talsis from time to time distinctly pass ovfer portions of its surface.
During normal quiet respiration the chest does not appreciably
expand, and the free border of the ribs, especially in young
animals, is drawn inward upon inspiration by the contraction of
the diaphragm.

These respiratory morements are reversed when the diaphragm is
paralyzed by cutting or excising a portion of the phrenic nerves
below the cervical plexi. The inspiration becomes laboriously thoracic
and is accompanied by a raising and flaring of the free borders of the
ribs, while the epigastrium sinks. Adult animals survive but for a lim-
ited period. Younger ones may live indefinitely, sustained solely by
thoracic respiration.

The movement of the chest in this instance is much more appar-
ent than the abdominal movement it replaces, for the reason that the
abdomen is much greater in size than the chest.

To revert now to man : We are well aware that in his normal condi-
tion he has not the predominant abdomen of the lower herbivora, yet
he does possess a well-developed diaphragm, and this implies the health-
ful *necessity of a greater or lesser amount of abdominal respiration,
according to the conditions of the individual.

But his greater expanse of chest over abdomen, his free and upright
position, the severe conditions of the circulation requiring an aspira-
tion of blood to the chest, the thickness of the abdominal wall, together
with the universal preference of workmen for a belt and as light
clothing of the chest as the conditions will allow, all show plainly the
predominance of costal respiration in man.

We say in man, for, although with womankind there has always been
a greater preference for a belt and freedom of the shoulders, and
whilst they frequently present a greater amount of apparent expansion
of the upper chest, the usual statement that " in man the respiration

68 Bureau of Gynaecology.

is more abdominal, and in woman more costal," is both untrue and mis-
leading.

The vital capacity of man is much greater, (by German statistics 3:2)
his bony chest is larger, his expansion is greater, and his abdominal
movement on respiration is also less than that of the chest.

It is evidently and chiefly because of the lesser development of the
chest in woman that its motions are more apparent than in man. The
greater softness of its tissues likewise favors the greater play of the
upper ribs, which both permits and is exaggerated by a compression
of the lower chest from a corset.

But we have made the observation that those who have a greater
necessity for free respiration preserve the custom of suspending cloth-
ing from the waist, leaving the shoulders freed from weight and the
chest unconstricted.

It is on the other hand easy to perceive that both braces and stays,
corsets and suspenders, have resulted from the increasing necessities of
individuals, because devoid of a natural waist, or whose occupations
were so- sedentary as to render uncomfortable the constriction of the
abdonien by a belt or tight clothing.

These fashions, however, have now become so general and so fixed
that they will not speedily wane, and we may leave them to time to
correct. But the question which is often asked, respecting weakly indi-
viduals, especially children : shall a corset— a loose corset — be worn, or
shall the clothing be suspended from the shoulders, requires an answer.
Let us consider the shoulders first.

We have already remarked the predilection of those who are sensi-
tive to their restriction for a relief from weight and a looseness of
clothing. This is especially noticeable in sailors. Yet such a rare
instance may lead us to doubt whether the whole matter does not well
govern itself, and the varying costumes of people as we find them, # be
not better than we can devise.

There are, however, at least two considerations to the contrary ; one
is that weight upon the shoulders, or constriction of the chest, either
above or below, inevitably restricts respiration, whether quiet or active ;
and the other is, that persons of a more or less sedentary life, breathing
less air, breathing much indoor air and having from less action a slower
circulation, should be rid of all embarrassment to respiration possible.

It is evident that the weight of clothing upon the shoulders must be
an embarrassment, for the mass of the shoulder itself, with the depend-
ing arm, is only kept from pressing upon the ribs in the upright posi-
tion by the muscles of the neck, chiefly the trapezius. Additional

ffrr

Bubeau of Gynecology. 69

weight of clothing is then embarrassing in three ways : First, by its
mere gravity ; Secondly, as an especial hinderance to the trapezius
muscle upon the belly of which it largely, and in the case of sus-
penders, mainly falls ; thirdly, by the friction of the depending cloth-
ing in inspiration, which rapidly increases as the breathing becomes
deeper, and of the three is, perhaps, the most active in limiting the
respiratory movement.

The advantage to respiration of relief from the weight of the arms
and shoulders themselves is apparent in the raised clavicles of a patient
in an asthmatic attack. The normal upward movement of the shoulder
in respiration is also to be readily observed in quiet as well as active
breathing, although it may not be apparent at a glance.

It is a fact to be borne in mind that man is an upright animal, and
while his free arms favor lateral expansion of the chest, tliis advan-
tage is offset by the weight of the upper extremities as a whole, which
press like levers upon the ribs of each side. It is, therefore, necessary
in the positions of sitting and standing that the head shall be held
upright to sustain the muscles of the neck, and the latter kept in con-
traction to give the upper chest free play. To point the matter, how-
ever, a mention need only be made of the fact that phthisis pulmonalis,
which carries off half of all civilized adults, rarely begins except in
the upper lobes of the lungs.

It seems altogether then that as little clothing as possible should be
suspended from the shoulders, and it would appear scarcely necessary
to add that this clothing should exercise no tension upon^full expansion
of the chest. Unfortunately, however, one may readily observe that
modern garments do not fulfill this condition. Whilst in an erect
position the plane of the back from arm to arm is quite flat, the chest
in front, from arm to arm, makes a marked bow and measures about a
quarter longer. Now in clothing made, with rare exceptions, the
same amount of difference will not be found. This is readily per-
ceived in the tension across the chest when an individual is requested
to take a deep breath, whilst at the back the garment only draws when
the shoalders are stooped.

If, on the other hand, we examine under clothing, as sold in shops,
it is almost universally found of the same breadth before and behind.

In a stiff shirt such a fault becomes aggravated, and observation
seems to afford ground for the view that round shoulders largely come
from unfit costume.

Our previous question remains, however : How shall clothing be
suspended from the waist that can be so suspended 2

1 .* »

"H!

Bureau of Gynaecology.

The various foregoing considerations, as well as the unwholesome-
ness of an impervious garment, exclude a corset, and suspenders, as
we have seen, are still worse.

How then shall a suspensary belt be arranged for those that are
sensitive or too stout for simple constriction at the waist ? To answer
this let me mention the device of our colleague, Dr. Roth, of London,
which as a means for the purpose is both sufficient and satisfactory,
consisting of an elastic band that stretches across the back from the
side seams of the trousers or other garment and is completed in front
by plain cloth flaps conforming to the figure.

In recommending this measure let me add, in conclusion, that those
individuals who wear light clothing and few wraps depending from the
shoulders thereby gain a certain protection against cold and changes of
temperature, for their better respiration keeps them warmer in con-
sequence.

*A Plea for Total Extirpation of the

CANCEROUS UTERUS UNDER

CONDITIONS.

A. R. Wright, M. D.,

BUFFALO, N. Y.

Doubtful surgery is not generally popular. Though fully sensible
of the delicacy of my position in advocating surgery that offers at the
present such slight inducement to the surgeon, a desire to know of
some more hopeful treatment of uterine cancer than the past history
of medicine gives us, has forced me to a consideration of this subject
Hearing of successful results of hysterectomy, after having a series
of the fatal uterine scirrhus, one begins to doubt if he has done his
whole duty to such patients until he has placed before them the chance
for prolonged life through this operation. Rarely do we hear of a
case of uterine cancer cured with medicine. I am well aware that
many of our ardent homoeopathic presuribers claim cures of this dis-
ease with their remedies. But I have yet to know of a single properly
diagnosed case cured with any remedy, homoeopathic, allopathic, eclec-
tic or specific.

*$emi-Annual Meeting 1886.

t . .41

Bureau of Gynaecology. 71

We hear, indirectly, of cures, but we cannot be assured that theie
was a correct and positive diagnosis.

Of all the cancer cures the Cundurango craze was the liveliest of
our day. Yet we had not a single authenticated case of cure from this
blissful remedy.

Dr. G. H. Payne, of Boston, f in a very careful and intelligent article
on the subject, first gives encouraging words for medical and local
treatment, then follows by saying that surgical interference " is the
only means that offers any ground for hope." Since, in the last few
years, the operation has been such a comparative success by very many
gynaecologists in Europe and America, we think the time has come
for us to consider well its expediency in certain cases. In regard to
the responsibility or decision for operating, hysterectomy for cancer
rests on an entirely different basis from the Battey-Tait oophorectomy or
" spaying." One is for relief from a condition not always fatal, while
ths other is for relief from certain death. Also the moral phases of
the two conditions differ greatly.

What experiences of others have we to warrant us in advising this
operation ? Schroeder says " Carcinoma uteri always presents an indi-
cation for hysterectomy, and possible recurrence should not deter from
its performance ; for all surgeons remove cancers regardless of their
return." I have not been able to obtain full statistics to the present
time, so submit these scattering reports, which give some valuable sug-
gestions. It is well known that for the last ten or fifteen years hys-
terectomy has been performed with gratifying success for various dis-
eases of the uterus. What follows is all the statistics we could readily
obtain on hysterectomy tfor uterine cancer. As early as 1879 the
operation had been performed in Germany by Kooks, Freund, Schroeder,
Martin, Mueller, Oishausen and Baumgartner and perhaps others.

At that time the operations were frequent in this country, but per-
haps more isolated than in Germany. Coming down more nearly to
the present time we find that Brenneche has operated by total extir-
pation for cancer eighteen times, and prefers this operation to amputa-
tion of the cervix. H. J. Garriguesff gives a compiled report of 135
cases of entire removal for cancer. Fritsch, of Breslau, recently
reported nineteen cases operated on. Success, as referring to the
return of the disease, could not be given, as the report was made only
fifteen months after the first operation, In February, 1885, Win,

iCarcinoma Uteri. Horn. Jour, of Obst.
ttSee Proceedings of N. T. Obst. Soo.

Bttkeau of Gtn-eooloqt.

;ave to the London Obst. Society statistics of 413 cases of
pation of the cancerous uterus.

ie choice between the operation by abdominal section or by
action, the following reported results are quite instructive :
nneche's eighteen cases were all by vaginal section without a
th. Fritsch's nineteen cases, of which only two were fatal,
iperated par vagina m, giving a mortality of 10J per cent.]
statistics give from 137 cases by abdominal section 99 deaths,
tality of 72 per cent., while the remaining 276 cases by
setion gave only 79 deaths, or a mortality of 28 per cent,
jue's report 94 operations by abdominal section gave 70
mortality of 74£ per cent., while 41 operations by vaginal
ve only 12 deaths, or 29.27 per cent.

iese results before us ought we not, in certain conditions of
licted with this dreadful disease, to present the alternative of
irpation of the uterus, and with a similar course of argu-
lat we would use for extirpation of a breast affected with the
use! If, in the interest of suffering humanity, we may be
!y allowed to take such a course we need not be quite so
?hen we are obliged to give the dreaded diagnosis, carcinoma

i may select our first cases with proper caution, I would sug-
ve take the following conditions as favorable for the opera-

ertain diagnosis of cancer.

! age, past the climateric period or under 30.

36 involving only the uterus.

en amputation of the cervix win not remove all diseased

en the general condition of the patient is favorable.

IT successful cases presented a spread of the cancerous W» parametric Hague.

REPORT

OF THE

BUREAU OF SURGERY.

J. M. Lee, M. D., Chairman, - Rochester.

Dre. F. E. Doughty, New York City.

Sidney F. Wilcox, New York City.

H. I. Ostrom, New York City.

M. O. Terry, ... ... Utica.

S. N. Brayton, Buffalo.

George Allen, Waterville.

With the invited co-operation of

Prof. H. F. Biggar, Cleveland, Ohio.

Prof. J. G. Gilchrist, Iowa City, Iowa.

*Obser vations on the Medical and surgical

Treatment of Tumors and cancers

of the Breast.

By M. O. Terry, M. D.

utica, n. y.

I intend this paper to represent my experience in the treatment of
these pathological conditions. The subject of this paper is one of
great interest to every physician and surgeon. Every practitioner has
cases — from the condition of induration of the breast to the progressed
stage of some variety of cancer — upon which he sits in judgment as
to the best method of disposing of them. It may be of interest to
you to refer you to a few valuable works on the subject. I therefore
note the following as worthy of perusal :

*Semi- Annual Meeting-, '86.

•V

7i Bureau of Surgery.

" Clinical Notes on Cancer.." Herbert S. Snow, Surgeon Cancer
Hosp., Brompton, Eng.

44 On Cancer of 'the Breast" Thos. W. Nunn, Middlesex Hosp.,
England.

*' A New and Successful Mode of Treating Certain Forms of
Cancer" by Alexander Marsden, Senior Surgeon to Cancer Hosp.,
London, Eng.

" Sarcoma and Carcinoma*" Henry Trentham Butler, F. R. C.
S., England.

" On Cancer, its Allied and Other Tumors, with special reference
to their Medical and Surgical Treatment" F. Albert Purcell, F. R.
C. S., England.

" A Treatise on the Breast and its Surgical Diseases" H. I.
Ostroin, M. D.

" Tumors of the Mammary Gland" Samuel W. Gross.

In these works will be found the differential diagnosis, the theory of
development, and the varying methods of treatment. Authors are
pretty equally divided as to whether cancers are hereditary or caused
by an injury of some sort. I am in sympathy witli those who believe
that cancer begins from an injury or an induration following an inflam-
mation, as an abscess for instance. In my clinical notes I may be able
to show why I believe in this theory.

An induration may remain stationary for years and finally pass into
the tumor state and from that into some form of cancer ; or it may
disappear either of itself by absorption or by the aid of remedies used
internally and externally. I am unable to say just what disappeared
in the three cases here presented. But it is my opinion that they were
all indurations.

Case 1. Miss Y., set. 35 years, had a hard formation in the left
breast the size of half a hen's egg. It had been noticed for ten years
but had remained stationary. As she was adverse to an operation I
gave her the benefit of the doubt and prescribed internally : Conium,
Phytolacca dec, Arsen. iod, Bellad., Dulcamara and Pulsatilla at
various times in tincture form, and a cerate of either Phytolacca or
Conium was used. In this case, as also in the two following, the
induration was not attached to the underlying tissue, was movable,
and the skin perfectly normal. This case cured in six months.

Case 2. Miss C, aet. 31 years, nervo-sanguine temperament; had
experienced pain in the left breast for one week, at which time she

Bureau of Surgery. % 75

noticed a "hard lump" the size of a walnut. She had received no
injury so far as she knew and could not say how long the hardness had
been in the breast. She was given the same treatment as Cash 1, with
intervals of cessation, for one year. I called on purpose to examine
the case to-day and could find no induration. Time of cure, one year.

Case 3. Miss W., set 32 years, nervo-bilious temperament; had
been married seven years. The induration, which was the size of a
small walnut, had been caused by an injury. It had been noticed for
only two and a half years. Under treatment it disappeared within
three months. N

We cannot say just when we have a simple induration or when we
have the iirfct transition, the adenoma, as only the microscope can
decide that question. At some time both conditions will exist at the
same period. The patient being under forty years of age, having no
pain, and there having been no change or increase in size, a short
course of treatment might be tried. The u lump " in the breast should
be as little manipulated as possible — at least no pain should be induced
by doing so. In the early period of a chronic induration massage
might be of use. All such treatment requires great discrimination and
judgment.

I shall now direct your attention to the results obtained by the
operative procedure from the simple adenoma to the scirrhus.

Case 1. Miss W., set. 40 years, nervo-sanguine temperament ; has
had a hard growth between axilla and nipple of right side for a num-
ber of years. It was removed and dressed with an antiseptic dry
dressing. The woand was healed perfectly in ten days. Analysis by
Dr C. Heitzman, microscopist New York City — adenoma.

I gave the doctor the specimen without any information as to location.
He said : " Should this nodule have appeared near the mammary
gland, or even in the axillary pit, it is what is termed an accessory
lacteal gland — pretty rare formations. It will not return."

Case #. Miss J., aet. 35, nervo-bilious temperament. She had a
tumor of the right breast removed three years previously by the
Kingsley caustic method. The tumor was removed but the ugly scar
the caustic left should dissuade anyone from using it. This had been
called a cancer, but it was undoubtedly at that time a simple adenoma.
With the above history I deemed an immediate operation advisable.
The tumor was the size of a small hen's egg, and there was an occa-
sional pain through it. It was constantly on the mind of the woman
that she had " another cancer " and that it would be short work with

76 Bureau of Surgery.

her. As the tumor was not adherent, the skin perfectly healthy, and
there was no axillary infiltration, I simply removed the part involved.
Dr. Heitzman, who examined it, diagnosed it a fibroma and said it
would not return. But it returned within six months. I then removed
the entire gland, examined the axilla, and found it free from infiltra-
tion or any induration. I informed my pathologist that he was " no
good," but this time sent him the gland. He replied : " This is a
' fibrosarcoma' of little malignancy — ' Clark's simple tumor.'" It
took me quite a while to find out nests filled with small globular
corpuscles, almost encysted by fibrous connective tissue, the latter
making up the greatest portion of the tumor. Lastly I found the
sarcomatous or myxomatous feature in it, quite marked, too. Sar-
comatous tumors are of comparatively little malignancy in the female
breast, and if thoroughly extirpated admit of a permanent cure."

There has been no return of the growth and there are no indica-
tions in the region of the cicatrix, or in the axilla, of any disease. «
The wound following the operation healed under the dry dressing in
ten days. A scaly formation appeared on the cicatrix six months after
the wound was healed. An application of Arseuious acid mixed to
the consistency of cream, with mucilage of acacia, cured this diffi-
culty. This is the preparation that Marsden, of England, used in cer-
tain forms of cancer.

Case 3. Mrs. B., set. 56 years ; nervo-sanguine temperament. The
breast had pained her for some months before she consulted her phy-
sician. As soon as he was consulted I was called to examine the case.
The right breast was very hard and was in one solid mass. The skin
was extensively infiltrated. Dr. Gross, of Philadelphia, who saw the
case, called the tumor u scirrhus" and stated that the lymphatic infil-
tration was due to pressure.

As he advised removal, it was extirpated. I was obliged to cut
through the thickened skin, which extended beyond the periphery of
the gland. The axillary glands, which were indurated, were carefully
pulled out and freed with the scissors. It might be well to remark
that the left breast was undergoing degeneration at the time of opera-
tion. The skin was very much infiltrated and the breast hardening.
The microscope showed the tumor to be a scirrhus or hard cancer.

Dr. Heitzman said: u It is of comparatively small degree of
malignancy. The fibrous connective tissue is largely in excess over
the epithelial nests, which latter are small and composed mainly of
single rows of epithelia. The prognosis, you know, is doubtful."
The patient lived just one year.

BurAau of Surgery. 77

Case 4- Miss G., eet. 41 years ; nervo-sanguine temperament.
About fifteen years since she received a poke of an elbow. When I
operated it had began to ulcerate. It was removed, together with the
axillary glands, which were greatly indurated. She died in eleven
months from constitutional poisoning, or cancer-cell absorption.

Case 5. Miss B., set. 37 years : nervo-sanguine temperament ; had
a tumor in the breast for ten years; removed it. Diagnosis —
fibroma. It is seven years since removal ; no return, but is married
and has had one child.

Case 6. Mrs. S., set. 68, nervo-lymphatic temperament ; weight,
185 lbs. ; had an immense growth of the right breast. It was evi-
dently a scirrhus. Axillary glands not involved. There was hardly
enough flap to close the wound. Healed in twenty days. Is now
feeling well in every way. Cannot say whether it will return or not.

Each will form his own conclusion in regard to the disposition of
these cases. In the stages between the induration and the malignant
growth, the knife is the safest, the most painless, and a comparatively
6ure means of relief. The removal of the breast, when suffering with
malignant disease, gives great relief to the patient, and is much easier
to dress and care for. Every difficulty of the breast should receive
prompt attention.

CASES OF MAMMARY TUMORS.

By George Allen, M. D.

WATERVILLE, N. Y.

Case I. — Mrs. M. W. T., aged thirty-five years ; has been married
several years ; no children ; dark complexion, eyes and hair ; is tall and
spare.

In October, 1863, she consulted me with reference to a tumor located
in the left breast. The tumor was of a stony hardness, smooth,
not sensitive to pressure nor painful at any time. It was situated
above and to the inside of the nipple. The nipple was not retracted
nor eczematous.

The patient stated that she had been aware of the presence of the
tumor six months, and that during that time it had not changed in
form or appearance.

78 BuBEATT OF SURGERY.

The tnmor at this time is about the size of a butternut. The
patient being averse to an operation, internal remedies were adminis-
tered six months, without any perceptible effect. The remedies
employed were Iodide of Arsenic and Iodide of Lime.

The patient's general health during all this time was excellent. At
the end of this period, however, the tumor began to enlarge slightly,
and an immediate operation was advised. On April 22, 1884, Dr.
M. O. Terry removed the tumor and with it a considerable portion of
the surrounding tissue.

The tumor was sent to Professor Heitzman, of New York, who
pronounced it a cancer, and stated that it would return, which it did.

Four weeks after nodular growths made their appearance near the
cicatrix of the first operation. These were removed in June, 1884.
Other nodules appeared, and were removed in July. In September,
still another crop of nodules appeared, and early in October the patient
went to the Hahnemann Hospital, in New York, and was placed under
the care of Dr. J. C. Minor, who removed all the cicatricial tissue, all
the nodules that were present, in fact, all the tissue down to the fascia
overlaying the pectoralis major, and even a portion of this muscle was
removed. He then extended the incisions and cleared out all the axil-
lary lymphatic glands.

After this operation no more nodules appeared for five months, when
one of small size was distinctly noticeable.

The Phenic acid treatment was now resorted to, using both the
hypodermic and internal methods of administration. For one month
there was no growth of the nodule ; at that time, however, a new one
appeared, and both were removed in March, 1885. Still others were
excised in May and July of the same year, one being above the clavicle
and overlaying the external jugular vein.

During all this time the patient's health had remained excellent ; in
fact better than usual. She recovered quickly from every operation,
most of the wounds healing by first intention. The patient suffered
no pain at any time. More than thirty cancerous nodules were
removed in the course of fifteen months.

After the operation in July, 1885, the disease changed in character.
No new nodules appeared, but instead a general and rapidly growing
induration began in every part of the mammary region of the affected
side. Signs of pulmonary induration at the upper part of the right
lung appeared ; a cough supervened, and the patient died in a few
weeks, suffering no pain, and escaping entirely the horrible features

BuBEAU OF SuRGEftY. 7&

which usually attend the closing stages of cancer when left to pursue
its course without operative treatment.

It is doubtful if anything could have saved this patient ; it is certain,
however, that much valuable time was lost at the outset by useless
waiting and the administration of remedies.

As it was, the patient's life was undoubtedly prolonged by the oper-
ations ; she suffered less and died easier than if the disease had pur-
sued its course without interference.

I believe this result obtains in nearly all cases. When operative
treatment fails to save life, it enables the patient to go through the
ordeal of this terrible malady with less suffering, and is better pre-
pared to escape the loathsome termination as often seen.

Case IT. — Lady ; aged forty years ; single. A tumor was removed
from the right breast eight years previously. This patient came to me
in September, 1884, having two nodules in the cicatrix of the former
operation.

The patient, who is a spiritualist, had had the first tumor removed
by a woman of the same faith, who claimed to act under the direction
cf Sir Astley Cooper. Sir Astley' 8 diagnosis was " scirrhous cancer,"
and according to his directions, the wound from the operation was
allowed to heal under a poultice of slippery elm.

The woman remained well eight years, when the nodules appeared
as before stated, a result, it was supposed, of extraordinary use of the
arms while acting as a masseur. x

These nodules I removed in September, 1884. They presented all
the characteristics of concerous nodules. There has been no return of
the trouble since, now about two years.

In this case, humoring the patient's whim, I allowed her to poultice
the wound as she had done on the advice of Sir Astley Cooper's ghost,
after the former operation.

Case III. — A married lady, aged forty-eight years, having a tumor
in the left breast which presented some of the characteristics of can-
cer. I advised immediate removal, although the diagnosis was doubtful.

On removal, a microscopist pronounced the growth a lipoma. The
patient remains well, now more than a year, and is happy in the assur-
ance that she has not a cancer — an assurance impossible to have
obtained without the operation.

'•.A,

*■*->*'

fe-

86 BuREATT OF SuRGERY.

MAMMARY TUMOR— WAS IT SCIRRHOUS?

By K. C. Moffat, M. D.

BROOKLYN, N. Y.

During convalesence from an injured elbow the patient was required
to carry a heavy weight. The strain of carrying was felt beneath the
left breast, and on one occasion a severe pain, as of something breaking
away, caused her to cease lifting or carrying.

A month later the breast came under my care, when I detected " a
glandular tumor" below the nipple, which soon became painless, and
fef<i ' treatment was discontinued.

]±:.y Two years later, (February, 1881,) the breast was again placed under

bi:- my care. There was now a roundish induration in the substance of

[£• the mamma, below and extending beneath the nipple. The breast felt

heavy and sore all the time, and there were sharp-shooting and stinging
pains, frequently recurring.

The patient was a maiden lady, aet. 35, of nervous, but not hysterical
temperament. Her general health was only disturbed by not infre-
quent obstructive (?) dysmenorrhea.

For three months I prescribed Con., Ign., Ars., Lach., without suc-
cess, TEtnd in April I submitted the breast and its history to Dr. W. M .
L. Fiske for diagnosis and suggestions.

The tumor was now lobulated three inches long, extending from one
inch within the nipple outwards, where it turned up toward the axilla.
It did not extend beyond the limits of the breast. The nipple was
somewhat in-drawn, but neither movable on the tumor nor absorbed in
it. Both nipple and breast were painful on handling, and were still
subject to pains as above stated. The axillary glands were not affected
and the dysmenorrheoea was neither greater nor less than customary.
The breast was larger than its fellow, and mis-shapen ; also constantly
painful by reason of its weight. Felt through the cellular tissue, the
induration seemed harder than gristle, and its lobulations were easily
recognized.

Dr. Fiske pronounced it cancerous, and fearing its further degen-
eration, counseled extirpation with the knife at once. To this the
patient objected to decidedly, that he proposed temporizing by the
trial of continuous pressure, till she should herself see that excision
was the wiser course. Accordingly broad bands of sheet rubber were

Bureau of Surgery. 81

Btretched across the breast, secured by gum diachylon to the skin
beyond. These were renewed once or twice a week, the skin being
kept in good condition by thorough ablution. Improvement in the
size of the breast was manifest in six weeks, though the patient
announced it by her feelings earlier. This treatment was kept up for
six months — progress during the latter months was slower than in the
earlier, because the reduced tumor was less compressed by the rubber
band through the overlying substance of the bosom. At the end of
six months compression was discontinued ; an ointment of Citrate of
Iron applied for three or four months more.

Ars. iodat. 3d. became the principle internal remedy, Iod. having
been found insufficient, but the above named were used according
their indications at the moment.

Five years later. — At present the general health of the patient is
good, dysmenorrhoea as formerly, being her bete noir. The afflicted
breast is' now smaller and less pendulous than its fellow, and a small
induration can be found by careful feeling beneath the nipple, but
there is no pain, and nothing else to indicate what it was, or has been.

•The Treatment of the Pedicle, in hys-
terotomy.

By II. I. Ostrom, M. D.

NEW YORK CITY.
Surgeon to Ward's Island Hospital.

With our present facilities for opening the abdominal cavity, and of
manipulating the abdominal organs, little more than the surgical risk
that attends any serious operation can be said to belong to this part of
hysterotomy. Nor are we to consider the removal of the uterus and
uterine tumor as the pivot around which turns our success or our fail-
ure. In hysterotomy, as in ovariotomy, the treatment of the part that
remains in the abdomen, not the part that is taken away, always has
been and always will be, the most important step in the operation, the
one, more than any other, that has to do with our mortality tables.

•Read by title, Semi- Annual Meeting, 1886.

/
I

82 Bubbau of Surgery.

I do not wish to underrate the value of the great care and attention
that have been bestowed upon the minor steps of hysterotomy ; hys-
terotomy would probably not be possible without them ; but at the
same time, I believe that some could be omitted — though we are rather
loth to take the initiative, not knowing how much each detail may con-
tribute to success — without danger, if the principal peritoneal wound,
the uterine pedicle, is properly dealt with. Accordingly, therefore,
the chief consideration in hysterotomy, is the management of the
pedicle.

The importance of this question is fully appreciated, and it is the
one that in connection with abdominal surgery is to-day discussed more
than any other : it is in truth the moot-point in the operation for the
removal of the uterus. We have therefore to inquire why this should
be so ; why this step in hysterotomy should outweigh in importance all
the other steps of the operation. The inquiry is necessary, for without
it we cannot treat the uterine pedicle in accordance with the well-
grounded principles of the healing of wounds, the application of
which will insure success in operative surgery. I cannot avoid the
conclusion that the hitherto high rate of mortality in hysterotomy may
in no small measure be traced to our failure to treat the lesions inci-
dent to this operation upon the same principle that we apply to other
lesions ; for from a surgical standpoint, I fail to find any reason for
considering the abdominal cavity as differing vitally from any other
region of the body. In all essentials, the processes of repair are the
same, whether we deal with the osseous or the nervous structure, with
connective or epithelial tissue ; and correspondingly, the same princi-
ples of treatment apply whenever wounds are to be healed.

The part that forms the pedicle, after removing the uterus, is com-
posed of more or less of the cervix, or possibly only of the vagina, as
in a case that I recently operated upon, where the entire uterine body
was occupied by the fibroid tumor, and I was obliged to throw
my ligature around the vagina before I could remove all of the
growth.

If the cervix is divided, and the cavity of the uterus opened, there
remains a rather fleshy stump, through the center of which is estab-
lished a communication between the abdomen and the vagina. This
stump is rather vascular, though the danger of vascularity depends
upon the size and character of the tumor that occupies the uterus. The
surface of the stump being uncovered with peritoneum, if allowed to
follow a natural course, will granulate, and suppurate, before it can
heal. There are, therefore, three indications to be met in the treat-

N BtTKBAtT Off SufcGEBY. 83

ment of the uterine pedicle, which for convenience we will discuss in
the order in which they have been mentioned.

The vaginal canal is the anatomical sewer for the pelvis, and upon
first thought it seems as if we should utilize this fact, and by some
contrivance convert the cervical canal into a drainage tube when one is
called for. But a moment's reflection will lead to a different conclu-
sion ; for, though the vagina occupies a most favorable anatomical and
mechanical position for draining the pelvis, this very fact is opposed to
utilizing it for that purpose ; because, being situated at the bottom of
the pelvis, fluids naturally gravitate there, and any artificial opening
that may be made, either in the vault of the vagina, or by amputating
the uterus, through which a drainage tube is passed, will expose the
patient to the danger of absorbing into the general system the effete
fluid that constantly lies in contact with the cut surfaces. A drainage
tube occupying the cervical canal is open to the additional objection,
that around it there would be difficulty in securing the stump properly,
and hence in bringing about rapid healing.

So far we have spoken of the baneful influences that proceed from
the abdominal cavity; it is very probable that still more harmful
ones — septic germs — are conveyed from the vagina into the abdomen,
when that cavity and canal are made to communicate, even though the
vaginia and uterine cavity have been rendered aseptic before the oper-
ation, and are afterwards kept as far as possible in that condition. I
am aware that some very successful surgeons still occasionally drain
through the vagina, but I cannot avoid the belief that by so doing they
increase the risk of an already grave operation.

We now approach the question, how shall we close the central open-
ing in the pedicle, and so avoid one danger in hysterotomy ?

If this is accomplished by constriction with a ligature that encircles
the entire pedicle — proposed by Kleeberg — the risk is encountered of
cutting off the nourishment from the distal end of the stump to such
a degree as to cause sloughing of that part. I do not say that this
necessarily follows leaving the ligature in situ, but that it may follow,
unless the cut surfaces of the pedicle establish vascular relations with
other abdominal organs and structures, cannot be doubted.

Principally to guard against this accident, and to control hemorrhage,
the extra-peritoneal, or clamp method of treating the pedicle, was
adopted, and is still adhered to by some successful operators.

Viewed as a surgical manipulation, it is simpler, and more expe-
ditious, to apply the clamp, and sew up the abdominal wound — such
cases do not often require drainage, which may be regarded as a favor-

• : ■» *■

84 Bureau of Surgery.

able circumstance. But are the principles upon which the exfra-peri-
toneal — I would rather say the extra-abdominal — treatment of the
pedicle is based, as truly scientific and simple, as are those that form
the ground for the intra-peritoneal — intra-abdominal method.

Let us pause for a moment to examine this question of principle,
the most important thing in science, and in life — a thing, the right
understanding of which must always decide for or against any matter
that calls for discussion.

We have here to choose between an external healing and an internal
healing ; between drawing a structure that naturally belongs in the
abdomen, out of that cavity, and retaining it upon the surface ; and
treating this structure as we treat . any other wounded structure — in
situ. With the external method, the pedicle is brought out of the
abdomen to control hemorrhage ; to avoid the absorption of pus, and
to prevent the possibility of adhesions forming between it and other
organs. In the internal method, the pedicle is dropped in the
abdominal cavity ; hemorrhage is controlled as we control it elsewhere,
by ligating the bleeding vessels, or by cauterizing them ; the presence
of a large suppurating surface is avoided, by bringing the edges of
the wound together, and so retaining them — as we do in other opera-
tions; the danger of contracting adhesions is guarded against, by
covering with peritoneum the surfaces that could give rise to such
adhesions. If we carry, this brief comparison to the length of time
consumed in the healing of the abdominal wound, the facts are greatly
in favor of the intra-abdominal method, for when the pedicle is so
treated the entire wound usually heals by first intention, and proceeds
without interruption ; but when the clamp is applied, the presence of
the sloughing and suppurating pedicle greatly retards the process of
repair.

I am well aware that the bulk of statistics is at present opposed to
the intra-abdominal disposition of the pedicle in hysterotomy ; but the
same was true a few years ago in ovariotomy, while to-day the most
successful ovariotomists have discarded the clamp, and drop the pedicle
into the abdomen. A few laparotomists, notably A. Martin, have
even now wholly abandoned the clanip in hysterotomy, and these men
deserve great praise for their boldness in trampling on tradition, and
applying in the face of experience, what they believe to be the true
principle of treating the pedicle. Their courage, and I am glad to
record their success also, should form an incentive for other operators,
not only to follow in their footsteps, but to go beyond their resting-
place, nor cease until, as a compensation for the mutilation that must

Bureau of Surgery. 85

be inflicted, we can exclude from abdominal surgery the tjiree factors
of non-success, inflammation, suppuration and septicaemia.

Tested by the underlying principles of operative surgery, and what
is known of the processes of repair, there can be little doubt that the
intra-abdominal is the most scientific and rational method of dealing
with the pedicle, and if it is not followed by success, we may be sure
that our application is at fault. With this more perfect, I hope to see
the day when hysterotomy will give as high a percentage of recoveries
as we can now record for ovariotomy.

Abstractly, there seems to be no reason why the removal of the
uterus — it not being an organ essential to animal life — should be
attended with a higher mortality than the removal of an ovarian
tumor. I will even go farther, and say that, excluding the proximity*
to vital organs, and vital functions, there is no reason why either the
uterus or the ovaries should not be removed with as little risk to life
as an amputation is now performed. Why should we continue to look
upon the peritoneum with the old-time dread ? and why fear that it
will play us false, notwithstanding that we treat it with consideration
and gentleness? The truth is, no structure of the body is function-
ally more favorable to operate upon than the peritoneum ; no
internal structure when wounded heals more readily and with less
constitutional disturbance than this serous abdominal sac. So power-
fully have I been impressed with this fact, from my abdominal opera-
tions, that I have come to regard the peritoneum as the protective
covering of the abdomen, and to insure it the continuance of this
office, I endeavor, as one of the most important steps in this opera-
tion, to leave this membrane, however much I may have been obliged
to mutilate it, intact, before closing the abdominal wound. That the
peritoneum, in operations that involve its structure, is prone to become
inflamed, and rapidly to pass through the different stages of inflamma-
tion, to a fatal termination, we can unfortunately illustrate too
often. Why is this? Chiefly, I apprehend, because we are not suffi-
ciently particular to repair the structure; because we do not with enough
care preserve its continuity, but leave some places uncovered that, follow-
ing the course of repair, become the source of contamination and infec-
tion. It was a step in this direction when Sir Spencer Wells proposed to
include the peritoneum in the abdominal sutures, and the effect was at
once perceived upon the statistics of laparotomy ; and it was a still more
important step towards success in hysterotomy, when Schrceder pro-
posed to cover the uterine pedicle with peritoneum, and so assist in
restoring the function of the lining of the abdomen.

• ►

-'• V

86 BtTBEATT OT SuBGERY.

; Though possibly irrelevant to the subject of how to treat the uterine
pedicle, I desire to anticipate any charge of inconsistency that may be
made, for the prominence that I have given to the necessity of pre-
serving the continuity of the peritoneum covering the stump, and the
silence so far maintained regarding the treatment of peritoneal adhe-
sions. But it must be remembered that when these adhesions are
broken up, the entire thickness of the peritoneum is rarely involved,
so there is still left peritoneal surface, the bleeding from which, as has
been shown by Mr. Tait, is usually controlled by sponge pressure. If
the adhesions are firmer, and necessitate deeper dissection, the condi-
tion becomes one of the most serious complications of laparotomy, and
is best met by the actual cautery, which leaves the nearest approach to
an inactive surface of any means at our command.

As a summary of what we have said of the two methods of treating
the uterine pedicle, extra and intraabdominal, I would enter a plea for
the application to this step in hysterotomy, of the recognized princi-
ples of operative surgery ; and for discarding those cumbersome appli-
ances, (as any purely retentive apparatus must be when compared with
curative treatment) that can seldom find a place in the surgery of the
nineteenth century.

So far as we have been chiefly concerned with the principles that
underlie the treatment of the uterine pedicle, and from these princi-
ples, as we understand them, have drawn the conclusion that the intra-
abdominal method answers the requirements of scientific surgery, and
is in accordance with the most advanced surgical manipulations ; and
have in consequence of this conclusion expressed the belief, in opposi-
tion to statistics, that this method, when perfected, will give better
results in hysterotomy than the extra-abdominal treatment of the
pedicle. The details of the intra-abdominal method may now justly
engage oijr brief attention.

And here let me disclaim any originality of procedure, save possibly
in one minor particular — the method of incising the stump. But
even in this I may not rightly be credited with priority ; all I can say
is, that I have not found the suggestion from any other operator.

After throwing an elastic ligature around the base of the tumor, or
uterus, as the case may be, A. Martin, by an eliptical incision, ampu-
tates the tumor; This leaves an excavated stump, at the bottom of
which the cervical canal enters. Now, in consideration of the after-
treatment of this stump, I prefer, when it is possible to obtain the
tissue, to transfix the stump with a straight-bladed bistoury, from before
backwards, and by cutting out and up, form the first lateral flap. The

Bureau of Surgery. 87

second flap is made by entering the knife at the initial point, and cut-
ting in the same manner, but from the opposite side of the stump ; by
this last incision thp tumor is amputated. We have thus two straight
flaps, made at the expense of a wedge-shaped piece of tissue removed
from the stump, above the ligature. These when brought together
make a good conicle pedicle, the surfaces of which can be more per-
fectly coaptated than when the eliptical incision is made.

The cervical canal is then brought together with interrupted cat-gut
sutures, and the elastic ligature loosened sufficiently to detect and
secure the bleeding vessels.

Since my last hysterotomy, in which there was considerable oozing
from the stump from vessels that could not be ligated, I have ques-
tioned whether in all cases it would not be well to pass the cautery iron
over the exposed surfaces. Wounds generally, treated in this way heal
very rapidly, probably because the cautery when not carried to the
extent of charring the tissues, stops this oozing, which always interferes
with healing by first intention.

The hemorrhage and oozing controlled the fleshy surfaces remained
to be disposed of. I think to Schrceder belongs the credit of suggest-
ing that this part of the pedicle should be held together with a contin-
uous suture, and that the peritoneum should be made to cover the
entire stump. This method of treatment is based upon the soundest
principles of operative surgery. We know that an aseptic wound,
whether rendered so by elaborate antiseptic machinery, or by strict
cleanliness, in which hemorrhage has been controlled, and from which
oozing has ceased, will heal without suppuration, if accurately brought
together and sealed. Now this is exactly what suturing the pedicle in
successive layers seeks to accomplish, and that such a result is thereby
accomplished, we find sufficient proof in the statistics of A. Martin
and Schrceder, both of whom have adopted this method of treating
the pedicle in their hysterotomies.

The method of introducing the sutures has much to do with ulti-
mate success. The best results will be obtained by holding the entire
surface of the wound in contact, and not the edges only. This may *
be accomplished by allowing the needle to traverse the length of the
wound, a few lines outside of its surface, very much as we introduce
the deep sutures when operating for the repair of a ruptured peri-
toneum.

Finally, the peritoneum is brought forward — in Schrceder's method
there remains a frill of peritoneum around the stump, after amputating
the tumor — and with fine sutures secured over the stump. It will

.V \

i,,i

•\'

* 1

88 Bureau of Subgery.

thus be seen that the wound is perfectly closed, and should give no
further trouble in the progress of the case. As the cut surfaces are
held in contact, and the hemorrhage, by this means, and by separate
ligatures has been controlled, the elastic ligature may with safety be
removed, and the stump dropped into the abdominal cavity.

From the importance attached to preserving the continuity of the
peritoneum, it may with justice be concluded, that the suturing of the
peritoneum is one of the principal steps in the treatment of the
pedicle. Other intra-abdominal methods of dealing with the uterine
pedicle have been proposed, as allowing the elastic ligature to remain
without suturing the serous membrane, or dropping the thoroughly
cauterized stump into the abdomen ; but, judged by the principles of
operative surgery, they do not seem to be perfect methods, nor have
their adoption been followed by the same good results — save, possibly,
in the hands of Mr. Keath, who, after cauterizing the stump, returns
it to the abdomen— that have attended treating the pedicle by succes-
sive suturing.

I have referred to my preference for the terms, intra-abdominal
and extra-abdominal^ as substitutes for the ones that are in general
use, to describe the two methods of treating the uterine pedicle. It is
a small matter, and turns upon the strict use of words. For example,
it is very evident when the pedicle is treated by successive suturing,
that the final set of sutures, those that secure the peritoneum, exclude
the pedicle from the peritoneal cavity, and the method by this manipu-
lation, is at once converted to an extra-peritoneal treatment of the
pedicle. But here arises a confusion of terms ; for extra-peritoneal is
usually employed to designate the use of the clamps or ligature to
secure the pedicle outside of the abdomen. It seems therefore, if we
would speak with accuracy, that we must use three terms to describe
the methods in vogue, of dealing with the pedicle. Extra-abdominal,
or the use of the clamp ; intra-abdominal, or any method that does not
include covering the pedicle with peritoneum; and extra-peritoneal,
or any method that secures the peritoneum over the pedicle, and
endeavors to preserve the continuity of the peritoneum.

* Supra-Pubic Cystotomy. (Clinical.)

By J. M. Lee, M. I).,

ROCHESTER, N. Y.

D. L. S., aged 67 years, came under my care during the current
year, through the kindness of Dre. Hurd and Dayfoot. He had been
ill for five years. While returning from a business trip he noticed
that he was not able to urinate in the usual way, but by getting over
on his hands and knees he could pass water as freely as ever. Finally
he waB unable to relieve himself even in this way, and the water had
to be drawn. Later large hemorrhoidal tumors developed about the
anus, which were operated upon ; this afforded temporary relief.
However, two years ago they returned and added materially to his suf-
ferings. It was unusual for him to hold his water more than an hour
at a time, and even then the last half was spent in acute suffering from
tenesmus both of bladder and rectum. The piles would protrude and
the only relief was found in drawing the water; the last few drops
were often bloody. This condition continued, with neuralgia about the
hips, in the testicles and down the thighs — of a shooting lancinating
character. Occasionally sharp darting pains passed from the bladder
along the perineum, and centered in the glans penis, which were
sufficient to compel him to start and groan. There was smarting,
burning pain in the bladder ; burning sensation in the soles of the
feet, which was very annoying and caused him to lie with them uncov-
ered. He remained in this condition until last January, when he con-
sulted Rochester's oldest 6urgeon, a " regular. " While catheterizing
him the instrument came in contact with a calculus. He made five
attempts, without an anaesthetic, to crush the stone, and succeeded in
removing the greater part of it. During the last operation a frag-
ment, about the size of an almond, was caught in the jaws of the
lithotrite and drawn through the urethral canal to within two inches
of the meatus urinarius, where it became arrested. Of course the
urethra was lacerated. While he was preparing to cut the fragment
out it crumbled and disappeared. Within a few days he made another

•Semi- Annual Meeting, 1886.

90 Bureau of Surgery.

examination under ether, and decided that the stone had all been
removed* Notwithstanding, after the usual time for convalescence
had elapsed, the distressing symptoms remained and were intensified,
probably from the excessive instrumentation. The patient, on inquir-
ing as to the cause of his continued sufferings, was informed that they
proceeded from a thickened state of the bladder, and that increasing
quantities of water should be injected twice daily to overcome it.
This, however, failed to afford the desired relief. He was confined to
his room the most of the time, being able to walk for a short distance
only. Many weary hours were spent in sitting over the edge of a
slop-jar, which assisted him to bear the tenesmus of both bladder and
rectum, the latter of which was very severe, as the piles were fre-
quently strangulated. This position enabled him to go from one-half
of an hour to two hours without resorting to tl)6 use of the catheter.
When I was called, March 27th, I made a careful examination with
the following result. Prostate gland enormously enlarged ; double
inguinal hernia; large prolapsed hemorrhoids; albuminuria; resistant
stricture three inches from the meatus ; palpitation and abnormal
heart sounds. On attempting to sound for stone, the searcher caught
in a false passage, made by the patient in trying to catheterize him-
self, so the effort was discontinued. Knowing that some of the symp-
toms might be due to the stricture, and that its presence prevented a
thorough examination, I decided to divide it. One week later, assisted
by Dr Dayfoot, I incised the meatus and stricture behind it to No.
40 f, after which a full sized conical sound passed easily. The wounds
were kept open, and at the end of two weeks were considered healed.
I then introduced the searcher, and detected fragments ef stone. On
April 28th, assisted by Drs. Dayfoot and Bissel, I crushed and
evacuated a portion of the pieces, by Dr. Bigelow's method. I now
became convinced that this operation was impracticable for their com-
plete removal. The patient was allowed to recruit for a few weeks,
and on June 10th, assisted by the same gentlemen, I performed epi-
cystotomy as practiced by Dr. Helmuth, with a few variations. The
bladder, which was quite ammoniacal, was washed out night and
morning for two days previous to the operation, with a saturated solu-
tion of borax. The night before the operation a dose of castor oil
was administered, and a thorough injection given the following morn-
ing. Just before giving the chloroform, which was preferred on
account of albuminuria, the bladder was washed out until clean, with a
solution of Calendula 1 to 100. The patient was then anasthetized
and placed on the table; the sonde-a-dard introduced and seven

Bureau of Surgeby. 91

ounces of calendulated water at a temperature of 100 deg. injected
through it, which, though a very small amount, was all that we con-
sidered safe to use. An assistant placed the colpeurynter in the
rectum and injected fifteen ounces of warm water into it, which caused
exceedingly severe spasms of the abdominal muscles, etc., notwith-
standing the patient was profoundly chloroformed — even, to stertor.
It was apparent that the operation could not thus proceed, and
about three ounces of water were allowed to flow out of the rub-
ber bag in the rectum. An incision two and one-half inches long was
made in the linea alba, terminating at the root of the penis. When it
was seen that the fold of peritoneum had not been elevated above the
site of operation, and must be cut, the wound was enlarged towards
the umbilicus to give room in which to work. The dissection was
carried on carefully and the peritoneum divided. The spasms of the
abdominal muscles, referred to above and the unusual straining, forced
theintestines out, and Dr. Dayfoot, though at home in such places, had
his hands more than full. The index finger of the right hand served
to elevate the peritoneum and bladder, which tissues were previously
secured by a loop of catgut, while the left hand guarded the opening
in the abdominal cavity. The blood being sponged away, the grooved
stilette was passed through the bladder, which was opened with a pair
of angular scissors placed in the groove. Three sharp fragments of
stone varying in size from an almond to a pea were removed by the
finger, from a deep pouch behind the projecting prostate, and the
bladder and wound cleaned. The incision through the bladder was
sewed with fine catgut, using Glover's suture. The protruding intes-
tines were replaced, and the incised peritoneum also closed with fine
catgut and continued stitch. The integument was brought together *
with No. 28 silver wire, to within one-half inch of the lower angle of
the wound, where a tent was placed nearly down to the bladder wall.
Calendula dressings were applied with plenty of absorbent cotton, and
finally a pad of marine lint secured by a flannel binder. Catheter
retained. "Within three hours reaction was established. Aconite was
prescribed and the patient showed no bad symptoms until the com-
mencement of the second day, when there was enormous gaseous for-
mation, greatly distending the stomach and bowels ; nausea and fre-
quent vomiting of a blackish watery substance. Although the utmost
care was taken in selecting remedies this troublesome and dangerous
condition continued until the sixth day. It was not possible to admin-
ister any food by the stomach, and rectal alimentation was resorted to.

•

92 Bubeau of Surgery.

For some time previous to tbe operation his stomach had been in a
catarrhal state, which I was unable to correct, and the irritation of the
chloroform upon the gastric glands afforded the most dangerous and
annoying symptoms during the progress of the case.

The urine flowed through the wound the greater part of the time
until the eighteenth day, when the catheter was removed and the
water drawn every two or three hours. The temperature was not
above 100 deg. during the progress of the case, and but for the weak
stomach not a bad symptom would have developed. At the end
of the fourth week he was about the room, and the sixth week left
Rochester, his old home, to visit his son in Richmond, Ya., having
good digestion and being quite free from urinary symptoms.

Case #. July 16th, J. C, aged 67 years, was placed in my hands for
operation by Dr. E. J. Bissell, who, with Dr. J. W. Buell, assisted me.
The patient was very much enfeebled from years of suffering with
chronic rheumatism, which had secondarily affected the heart.

Operation same as above, but easier. Usual amount of . water
injected into the bladder and rectum without the slightest difficulty.
Incision two inches long; peritoneum not seen; stone encysted and
turned out with the finger. Bladder wound not sewed ; integument
closed with wire as usual, and tent retained in the lower angle of the
wound./ Catheter not retained — allowing the water to flow freely
through the wound until the end of the fifth day, when it ceased for
a time — then the catheter was fastened in the bladder. Bronchitis
set in on the eighth day, and a little later a colliquative diarrhoea.
These diseases well-nigh exhausted his remaining strength and the
healing process was apparently arrested for several weeks. Finally
he began to gain, and no urine passed through the wound after the
thirty-ninth day. He is now about his business, and considers himself
well. The highest temperature was lOOf and this was present one
evening only, after which it gradually assumed the normal point.

None of the popular antiseptic " daubs or squirts " were employed
in either case, but Aconite, Nux vom., Ars., Hepar sulph., Rhus tox.
and Carbo. veg. were given according to their specific indications.

It will be noticed that I did not sew the bladder in the last case ;
however, I think the tardy healing was in no way due to this, as the
state of the patient was incompatible with the repair of wounds.

Treatment of Fibroid tumors by Elec-
trolysis. DR. APOSTOLl'S METHOD.

By Wm. H. King, M. D.,

NEW YORK CITY.

Mb. Pbesident, Ladies and Gentlemen : My object in presenting
this subject to you is : First, to give a full account of the various steps
of the operation, so that any physician possessing a good knowledge of
gynaecology and but a limited knowledge of electrophysics, can safely
and effectually treat a case ; second, to give the result of observations
both in my practice and at Dr. ApostolPs Clinic, of Paris, which I
attended during a part of last July and August.

The apparatus needed should have a careful consideration.

A galvanic battery capable of generating 250 milli-amperes, with a
selector that will introduce any number of cells without interrupting
the circuit, must be chosen. Of course, some form of a cabinet bat-
tery is to be preferred, as there is no acid to corrode the connections,
and it is always in order ; but an ordinary zinc-carbon battery may
answer the purpose, if it is kept in good condition.

The external electrode should be large enough to cover all the avail-
able space of the abdomen, thus reducing the resistance to a minimum.

You will hear many say that any large electrode will answer. I wish
to disabuse your minds on this point. The large mesh electrode, cov-
ered with absorbent cotton, which is so highly recommended and so
much used in this city, I consider useless for this purpose, for I have
been unable, when using it, to pass a current of 250 or even 200 milli-
amperes without causing excruciating pain, and, in most cases, blister-
ing the abdomen. The one used by Dr. Apostoli is made of potter's
clay. It is not elegant, but is very effectual ; and, if properly made,
can be used without soiling the patient's linen or abdomen. The best
material to be obtained here for making it is the finely ground clay
used by artists for modeling, which can be obtained at stores dealing
in art materials. A piece of ordinary muslin may be used ; but I pre-
fer a towel which has been worn until it has become smooth and soft.
This should be so cut that, when folded upon itself, it will be of the
required shape and 6ize. The edge* are sowed together, leaving a

94: BUREAU OF SUROERY.

space large enough for the hand to enter. The clay, well moistened,
is packed carefully in the sack from one to one and one-half inches in
thickness. A brass plate, soldered to one end of a copper wire, with a
connector on the other end, should now be imbedded in the clay and
the opening in the sack closed around the wire. This electrode must
be kept moist, which can be easily done by keeping it in a little water
in an ordinary dripping pan. It will then always be ready for use, and
is certainly the most effectual one I have ever seen. Two hundred and
fifty milli-amperes can be passed through it without causing pain or
any perceptible redness of the skin.

The internal electrode used by Dr. Apostoli is a small bar, twelve
inches long and the size of a number eight French sound. One end
j8 made of platinum and iridium, and shaped like an ordinary uterine
sound. The other end is made of steel and has a trocar point ; this is
used for making punctures.

A milli-ampere meter is absolutely necessary to success. It is not
my purpose to dwell on its construction. It is simply an instrument
by which the intensity of the current can be told at any time, thus
making the electric current mathematically u doseable."

The Operation — There should be a distinction made here between
the hemorrhagic and non-hemorrhagic, for one requires just the oppo-
site kind of treatment to the other. With the former, the positive
pole of the battery should be attached to the internal electrode, with
the latter the negative. Please bear in mind these distinctions, for a
treatment might prove most disastrous if you introduced the negative
electrode into a uterus containing a hemorrhagic fibroid.

The patient is placed on her back,, the thighs flexed in position for a
bivalve speculum. The abdominal electrode is first placed in position,
so that the skin of the abdomen mav become moist, before the current
is allowed to pass. . The platinum end of the internal electrode is then
inserted into the. cavity of the uterus and a celluloid or hard rubber
shield passed over it until it reaches the os; this is done to protect the
vagina and external parts. After this, a handle, which also serves as
a connector, is passed over the steel end of the sound until it reaches
the insulating shield and is made firm by a set screw. The current is
then turned on. At the first treatment not more than twenty to thirty
milli-amperes should be allowed to pass until the patient becomes
accustomed to it, when fifty to one hundred may be used.

At each treatment you will be able to increase the current ; but this
increase will differ with different patients. With some not more than
150 to 200 can be used ; but with the majority, if carefully handled,
you will be able to pass 250 to 300 milli-amperes through the tumors.

. »*-

'J®

i V,

Bureau of Surgery. 95

This must be done without causing any severe pain to the patient,
for if the operation is too painful, you will not be successful.

These very powerful currents are the secret of success in this form s ^
of treatment of fibroid tuhiors, and, unless you can pass 150 milli- "'^|
amperes through the tumor, you will not be successful. Dr. Apostoli v ^
attributes nearly all his failures to an inability on part of the patient to ;$|
bear a strong current. This may be due to pelvic inflammation, but >:|
more frequently to a hysterical tendency. » i$

The directions given above are those to be followed when there is <;J|
no obstruction to the passage of a sound into the uterine canal. When
such obstruction exists, a puncture should be inade, if possible, through
the cervix, but never more than one and a half to two inches, with the
trocar end of the electrode and the negative pole always attached.
This generally requires an anaesthetic, although it is not unbearable
without it. The external electrode is placed the same as before, to
which is attached the positive pole, and a current of about 150 milli-
amperds allowed to pass for ten minutes. This opening will remain
for some time, and is used for the introduction of the sound in after
treatments.

Another method of treatment which has been employed by Dr.
Apostoli is to puncture the tumor in its most prominent part, if possi-
ble, through the vagina, if not through the abdominal wall,* with a
needle insulated to within an inch of the end and connected with the
negative pole of the battery.

Many seem to be particularly afraid of puncturing the peritoneum ;
but I believe it can be done in most cases, with proper precautions,
with impunity, for I have punctured it a number of times with a large
electric needle, and only saw the least b?d effect once, when the insola-
tion of the needle was at fault. The time of which I speak a strong
current was used, and from the exposed surface of the needle, the per-
itoneum must have been considerably disturbed. The only result of
this was soreness over a circumscribed area of four inches for a few
days, no fever accompanying it.

The precaution I would urge upon you, aside from thorough anti-
sepsis, is to have the needle thoroughly insulated with hard rubber and
not trust the patent varnish insulators of different manufacturers.
There is another precaution which should be mentioned. In punctur-
ing a fibroid tumor with insulated needles, the current should not be
long enough or of sufficient intensity to induce suppuration.

With all these operations, the law of antisepsis should be thoroughly
observed. The vagina should be washed with an antiseptic solution

'>: * .

<*•'

• z ""•

**6 BlTMEAtJ OF SUBMRY.

before and after each treatment, and when a puncture is made, the
patient should have a pledget of antiseptic gauze continually in the
Tagina.

Exactly the way this treatment reduces a fibroid tumor, I do not
profess to know. Nearly all agree that the cauterizing, hardening and
contracting effect of the positive pole is the process by which the tumor
is reduced, when that pole is used. There is more speculation regard-
ing the effect of the negative ; but all agree that it reduces a tumor
more rapidly than the positive.

Dr. Apostoli thinks its effects are due to an over congestion and con-
sequent destruction of the molecules. Others believe the tumor is
composed of certain electrolytes, which are decomposed by the current
and are then absorbed.

If I digress further on this point, I would be losing sight of the
second object of this paper, the results which are obtained.

These may be divided into two classes. First, the changes noted in
the pathology ; and second, the change in the symptoms and, the gen-
eral condition of the patient. One of the first changes in the path-
ology is the breaking up of the adhesions. The tumor which was
before immovable, becomes movable. I have also noticed this as one
of the first changes when treating an ovarian tumor by electrolysis.
The tumor also begins to decrease in size, which will be recognizable
both by external manipulation and internal measurements. The retro-
gression will continue for some months after the treatment is discon-
tinued.

I was much surprised on my return to this city this month, on
examining a patient I had treated last Spring, and who had had no treat-
ment for two months, to find that the tumor, so far as I could perceive^
had decreased in size just as fast while I was away as when under active
treatment.

Dr. Apostoli has noted the fact that, under treatment, the tumor
tends to partially separate from the uterus and become pedunculated.
This I noticed in two cases in his clinic, and one in my practice, a ring
of depression at the attachment of the tumor to the uterine wall being
distinctly felt through the vagina.

We have much more marked changes in the symptoms and general
condition of the patient than in the pathology. If it be a hemorrhagic
fibroid the hemorrhage will almost immediately stop if the positive
pole is used internally and the patient be able to bear a very strong
current.

Bureau of Surgery. 97

Striking as this may be, it is not more so than the improvement in
the general health and constitutional symptoms. The appetite
improves, the patient sleeps well, gains flesh, and feels much better in
every respect. Fat accumulates in the abdominal wall, the local symp-
toms one by one disappear, and this same good effect will continue,
under proper treatment, until the cure is effected.

Although I have never seen a fibroid tumor entirely removed by
electrolysis, 1 have yet to see a single case that has been under treat-
ment a sufficient length of time in which every symptom that could
be traced to the tumor did not disappear, and this relief, so far as I
know, has been permanent.

I saw cases in Paris treated by Dr. Apostoli two, three and four
years ago which were as well as when discharged from the clinic.

That there are cases which are but slightly or partially relieved, I
know ; there must be many, only I have never seen one.

I will not tax your patience longer. I wish to say, in conclusion,
that success will not be obtained by careless treatment, but only by
strict adherence to all the minor details and a careful study of each
case.

RADICAL CURE OF HERNIA.

By J. G. Gilchrist, M. D.,

IOWA CITY, IOWA.

The text-books and periodicals, for many years, have had much to
say of hernia abdominalis. The general interest felt in this subject is
easily explained and understood when we recall the very serious nature
of the condition. Whether hernia is recent or ancient, acquired or
congenital, every movement is one of danger to the sufferer. Accord-
ingly, for many years, surgeons have been busy devising operations for
its cure, so that the number of " radical cures " is very large. Some
of them had a very brief life ; others survived, in spite of portentous
failures, for a generation or two. Most of them have dropped out of
sight entirely, but now and then an old method will be revived, modi-
fied and u improved," but it quickly goes back to oblivion (again).

98 Bureau of Surgery.

The earlier idea was that the canal was to be closed up, either by
invagination, or in some manner by reducing its dimensions, and among
the majority of operators to-day, the same ends are sought. The opera-
tion usually results in failure, no matter what the particular method be,
from a failure to recognize or appreciate the importance of certain
predisposing conditions, and for the want of proper medicinal treat-
ment of the case after an operation has been made. It may be stated
as roughly a fact, that the cause of hernia is not, by any means, to be
looked for in the patency of the vaginal process, or an unusual size of
the abdominal rings. Certainly these conditions are important factors
in the causation, but are rarely, if ever, of such importance that other
and more potent ones are to be ignored. The chief cause is found to
be an elongation of the mesentery, practically producing such augmen-
tation in bulk of the contents of the abdomen, that the capacity of
that cavity is insufficient. It is true that the loss of support, when the
canal or its rings are too capacious, favors such traction on the mesen-
tery, that elongation is, sooner or later, produced ; but with these out-
lets intact^ if the mesentery, from any cause, becomes elongated, a
hernia will, nevertheless, appear. There can be no question that a
radical cure of hernia cannot be secured without closing the canal ; but
if this is the sole treatment, my experience leads me to state most con-
fidently, few patients will remain cured.

It has been my fortune to make very many operations, probably all
the legitimate ones, even to the very doubtfully " legitimate " Heaton-
ian. I am of the opinion that my success has been probably as good
as others, but the number of positive cures has been very small until
quite recently. For the past year or two the successful cases so far
outnumber the unsuccessful that I confidently expect, if not an absolute
cure, at least a marked improvement on the former state. The proced-
ure, as far as the instrumental part is concerned, varies slightly in
different cases, but is generally as follows :

The part is shaved quite closely, and a fold of the integument
pinched up over the external ring and transfixed with a curved bis-
toury, making an incision of from an inch to an inch and a half in
length. The fat which now appears is broken through with the finger
or the handle of a scalpel, or incised, if necessary, and the incision
deepened until the ring is brought into view. Now if the sac is not
too voluminous, or too much thickened, it is pushed up into the canal
until the lower portion, at least, is fairly filled with it. A needle
armed with catgut — carbolized or not is a matter of utter indifference
— is entered into the mass of the sac and brought out well beyond the

Bureau of Surgery. 99

pillar on either side ; the needle is unarmed and armed again with the
other end of the catgut, and used in the same way on the other side.
The ligature is then drawn tight, knotted, and the ends cut off, bring-
ing the pillars together, and retaining the plug formed by the sac
in the canal. This stitch is taken in about the middle of the pillars.
Should the ring be very large I freshen the edges with scissors or
knife, and insert two or even more stitches. Should the* sac be vol-
uminous and too vascular, after stitching it in the canal it is ligatured
by transfixion and cut off. Up to this point there is little, if anything,
peculiar or novel in the operation, nor in the closure of the external
wound, which is by means of interrupted sutures of silk. Over the
wound I place a compress of absorbent cotton, saturated with a solu-
tion of Hypericum, about ten drops of tincture to two or three ounces
of water, securing it in place, as well as furnishing support to the parts
by a snugly applied spica bandage. The patient is then put to bed,
Cautioned to apply the hand over the wound in coughing or vomiting,
as well as in urinating or going to stool. The compress is not to be
wet with the Hypericum again, but the remedy is given in any dilu-
tion, the thirtieth preferable, about once an hour. After twenty-four
hours have elapsed, the bandage and compress are removed, a dry com-
press applied and a new bandage put on ; the Hypericum is to be con-
tinued for two or three days longer. When the external wound is
fairly healed a light truss is to be applied, one with a flat pad, with
either a very weak spring or elastic straps, and the patient permitted
to go about the house. In fact, he can usually leave the bed for a
chair about the fourth or fif *h day, but must be careful to apply the
hand over the wound while moving from chair to bed. About the
tenth day he may leave the house, never without the truss, which
should be worn until the parts are evidently healed. The truss is to
be worn during the day, and after lying down at night must be
removed. In the morning it must be replaced before rising. These
rules are imperative. After the third ox fourth day, as soon as the
Hypericum is discontinued, commence giving Lycopodium 80 three
times a day for two weeks, then twice a day for two weeks, afterwards
once a day until there is evidently no disposition to a reappearance of
the hernia. This item in the treatment I esteem sine qua non. I was
led to employ this remedy on the authority of the late Dr. Holt, of
Massachusetts, the first case being as follows :

A young man had a large inguinal hernia on the left side, which
came down into the scrotum whenever the truss was removed. It had
never been straugulated, but his truss not being comfortable, he applied

► - : *a: ml *•• ± •; '
i • ■'; i. *?<' t •■ * ■■

MO Bureau of Surgery.

for a radical care. The operation was made, as above, and for a time
all seemed well. After about six weeks a bubonocele appeared on the
right side. Recalling Pr. Holt's experience, I gave Lycopodium 30,
purposing to make a second operation at a later period. The bubon-
ocele disappeared, and during the two or three years I had him under
observation, did not return.

A second case was one of double inguinal hernia, that on the left
side being dpuble the volume of the right. A double operation was
made. The left hernia did not again appear, but after a time that on
the right became prominent. Lycopodium was given as above, and all
trouble passed away.

There are many such cases in my case-book, and finally the question
naturally arose, why wait for the reappearance of " the hernia? Accord-
ingly it became a habit to give Lycopodium as a matter of course, and
the result in about forty cases seems to justify the practice. In my
last fifty cases, as far as I have been able to learn, there has not been
one that has not been vastly improved, and the large majority (thirty-
four) may properly be claimed cured.

There can be no doubt that the desirable shortening of the mesen-
tery is secured by giving the Lycopodium.

PEROXIDE OF HYDROGEN IN THE TREATMENT

OF ABSCESS.

By George Allen, M. D.,

WATERVILLE, N. Y.

Peroxide of Hydrogen, Hydrogen Dioxide, Oxygenated Water,
H 3 2 ; such are the chemical names for the substance to which your
attention is directed in the present paper. In the pure state it *is " a
colorless, syrupy liquid," having a disagreeable metallic taste, slightly
caustic properties, and possessing the power of bleaching the tissues
with which it comes in contact. 1 u The various bleaching agents used
to convert brunettes into blondes are dilute solutions of oxygenated
water." l u In the pure state it is very unstable and decomposes at

1 Witthaus' Medical Chemisty, p. 67 and 68.

Bureau of Subobey. 101

ordinary temperature ; diluted with water, however, it is 1 compara-
tively stable and may be boiled or even distilled without suffering
decomposition."

Hydrogen peroxide was discovered in 1818 and has been used in the
arts since that time ; it is only within a few years, however, that it
has been used in medicine.

Philips 8 says it has a marked antiseptic power and quotes Guttman
to the effect that urine mixed with one-tenth of Peroxide remained nine
months without putrifying action. A recent writer in the Medical
Hecord? says of Hydrogen peroxide : " Recent investigations seem to es-
tablish its claim as one of the most potent destroyers of bacterial life.
" Careful comparative tests prove it to be sixty times as powerful as
" Carbolic acid, twenty times as strong as Salycilic acid, and 40 per
" cent, more potent than the solution of the Bichloride of Mercury."
The writer still further says that " extraordinary as this may seem
experiments place it beyond a doubt." Nothnagel & Rossbach 4
affirm that " the secretions from chancres and buboes loose their infect-
" ing power in the presence of Hydrogen peroxide in somewhat large
" quantities." The action of this agent on pus is remarkable. If a
few drops of a 10 per cent, solution be brought in contact with pus a
brisk effervescence ensues, which continues till all the pus is com-
pletely destroyed. The same action occurs in the presence of yeast, 4
various ferments, freshly drawn blood and diphtheritic membrane.
The effervescence noticed is due to the decomposition of the Hydrogen
dioxide and the yielding up of one equivalent of oxygen. This
equivalent of newly liberated oxygen being in the " nascent state "
possesses more active properties than usual and rapidly oxidizes the
organic substances with which it comes in contact, thus destroying pus,
bacteria, fungi, etc. To this powerful oxidizing property, therefore, is
due, doubtless, its great efficiency as an antiseptic.

Its uses thus far have been directed to the cleansing of foul ulcers,
and to a limited extent in ottorrhcea, purulent and diphtheritic ophthal-
mia and gonorrhoea ; also as a local application in diphtheria. Dr. C.
F. Sterling 6 in a paper before this Society in February, 1885, spoke of
the value of this agent in purulent inflammations of the middle ear.
My own attention was called to its use by Dr. H. M. Paine, the honored
President of this Society, from whom I obtained the first specimens for
use. This was an aqueous solution of "ten volumes" containing 2.1

1 Witthaus' Medical Chemistry, pp. 67 and 68.

2 Materia Mediea— Inorganic Subs. Vol. 1, p. 16— Wood's Ed.

3 J. Mount Bleger in Med. Kec, Aug. 13, 1887.

4 Mat. Med., Vol. 1, p. 310— Nothnasrel & Rossbach.

5 Trans, of the Horn. Med. Soc. of the State of N. Y M Vol. XV, p. 218.

102 Bureau of Surgery.

per cent, of H 2 8 , and in my practice has been still further diluted
before using by the addition of twice its bulk of water, making a
strength of about one to three of a ten volume solution.

Dr. Paine writes concerning it : "I always use it at fir3t, in every
"case of ulceration. When the secretion of pus ceases 7 I usually
" change for some other remedy, frequently Iodoform, hence " I can-
not report as to its positive effects." My object in this paper is to
speak of the very great value of this agent in the treatment of
abscesses of every sort. I have used it as follows : After opening an
abscess and allowing the pus to escape, the cavity is filled with a
solution of the Peroxide of Hydrogen, from a syringe. A brisk effer-
vescence ensues as the fluid escapes, and this continues till all the pus is
destroyed. No pain is experienced from its use in this strength. The
result in my cases was that the secretion of pns diminished rapidly
from the first application of the remedy — the cavity in every case
closed with corresponding rapidity, so that a large abscess whose
closure, by ordinary treatment, would be a matter of weeks, was brought
to a termination in a few days. The following cases are illustrative of
its action :

Case I. Phlegmonous erysipelas of both legs. An abscess formed
in each, which discharged on opening about a coffee cup of thin,
dark, sanious pus. The abscess which first appeared was washed out
with a solution of Bromine for two days, but the secretion of pus
continued to be profuse and the cavity remained the same size.
The Bromine was then discontinued and a solution of Peroxide of
Hydrogen substituted. After the first injection there was scarcely any
further secretion of pus, though the cavity was washed out daily with
the Peroxide solution. It rapidly diminished in size and was practically
closed within a week.

Case II. "Was on the other leg of the same patient. The Peroxide
solution was used as soon as the abscess was opened. The result was
equally rapid and satisfactory as in the first case. These abscesses
occurred in an alcoholic patient, one of that class of cases in which
there usually occurs a considerable sloughing of cellular tissue, and
whose progress is apt to be slow and tedious. Under use of the Per-
oxide of Hydrogen there was no sloughing of cellular tissue whatever,
and the progress of the cure was neither slow nor tedious, but on the
contrary, very ra pid and highly satisfactory.

Case III. Was a large abscess, located in the left side of the
pelvic cavity. From this location the pus burrowed among the tissues
of the abdominal parietes and found exit through the right lumbar

Bureau of Subgery. 103

region. The sinus which connected the abscess with the opening
was about twelve inches long. A rubber drainage tube was intro-
duced through the sinus, and the abscess washed out daily with
a solution of Peroxide of Hydrogen, followed by one of Carbolic
acid. This case was an unusually bad one to manage on account
of the great length of the sinus. Under the treatment pursued, how-
ever, the pus, from having been horribly offensive, lost its offensive char-
acter, and in a few days, became entirely laudable and greatly dimin-
ished in quantity ; the constitutional symptoms, which had been alarm-
ing, disappeared and the abscess closed in a much shorter time than it has
been my lot to witness in other similar cases. To be sure Carbolic acid was
used, but never have I seen this * agent produce such marked and
rapid changes as were seen in this case ; so that it seems reasonable
to attribute the results obtained to the use of Peroxide of Hydrogen,
especially as they are entirely in harmony with those obtained by the
use of this drug in other similar cases.

Case IV. Is one which I am enabled to report through the
kindness of a brother practitioner 6 and as the Peroxide was the
only agent used, the case is all the more valuable as illustrating the
positive effects of the drug.

P. M., a male aged twenty years, ha<} a large abscess extending from
the clavical on the right side downward as low as the tenth or eleventh
rib, apparently lying under the pectoralis major muscle and over the
serratus magnus anticus and external oblique abdominis. Free
incision was made, and gave exit to from sixteen to twenty ounces of
pus (estimated). An oakum pad was applied, as the only dressing.
Two days later a solution of Peroxide of Hydrogen (10 vols.) diluted
with water in the proportion of one drachm to twelve ounces (about
1 to 100) was injected into the abscess from a fountain syringe. There
was no difficulty in injecting about eight ounces at this time. Two
days later only one ounce of a similar solution could be injected.
This Peroxide preparation was used only four times, at intervals
of about two days, and was the only fluid injected. At the end
of this time the abscess had healed and the opening closed. This
case occurred in an anaemic poorly nourished subject, phthisically
inclined, and was a very unpromising case 60 far as the expectation of
a speedy recovery was concerned. The solution used was very, dilute,
but the results were none the less prompt and satisfactory. I have
also used the Peroxide as an application to lacerated wounds
and ulcerated surfaces, when suppuration was profuse, with the reault

e Dr. C. Wilaon, Waterville, N. Y.

104 Bureau of Surgery.

in every case of diminishing the suppuration and promoting the healing
process. Dr. Paine speaks of its value in ulcerations and abrasions of
the 08 uteri.

From the foregoing, therefore, I am led to conclude that in the
Peroxide of Hydrogen we possess an agent of great value for the treat-
ment of suppurative processes of every kind, and particularly for the
treatment of abscesses.

The Before and after Treatment of

Laparotomy.

By H. I. Ostrom, M. D.,

NEW YORK.

Laparotomy has become a surgical fashion. Surgeons seek to demon-
strate' that the majority of pelvic lesions are amenable to operative
treatment, and that the abdomen can be opened, its contents examined
and neoplasms removed with little more than ordinary surgical risk.
The newness of the operation and the brilliancy of the results obtained
have naturally led to its somewhat indiscriminate performance, but
abdominal surgery now rests upon too firm a basis, and the benefits
conferred upon our art by the pioneers in this department of surgery
are too well recognized, to require defense at this time. If some lives
have been sacrificed to a principle, more have been saved from a life
of suffering, or from death itself ; and the names of Wells, Thornton,
Keith, Tait and a score of others, will remain as monuments of cour-
age and personal sacrifice, and as synonyms of " healer of the sick."

Within its brief history abdominal surgery has made phenomenal
progress. The success which to-day attends the various operations that
may be classed under that head, was, even in the prophetic brain of
McDowell, scarcely dreamed of. The causes that have led to this suc-
cess are the same that influence general operative surgery ; the same
that make it possible for Victor Horsely to diagnose and successfully
remove cerebral neoplasms; the same that enables you and me to under-
take with some degree of confidence and with comparatively little fear

Bureau of Surgery. 105

of inflammation and septicaemia, operations which would have caused
surgeons of a century ago great anxiety and possibly bitter disappoint-
ment. •

As we study the early work of Sir Spencer Wells, — I refer to him
because he was among the first who made a speciality of abdominal
surgery, — *),nd that of his more successful colleagues, we receive the
impression that the practical application of general science, if I may
be allowed the expression, the catholicity of modern surgery, is directly
associated with our present low mortality rates. All science is one.
The impetus given to the surgery of to-day is derived from histology,
biology and chemistry, each branch of learning contributing to the
general fund. The mental activity which we see on every side and
and in every walk of life, the general desire for scientific investigation
knowledge, almost unprecedented in social history, the craving for
original research with which the latter part of the nineteenth century
is redolent, are the matrix out of which is born our improved instru-
ments, our better methods of operating, our aseptic and antiseptic sur-
gery. Not to the surgeon alone is credit due for his unerring skill in
reaching disease, and the impunity with which he seems to defy organic
structural laws. Mr. Tait must share his honors with Darwin, Spencer,
Tyndal, Pasteur, or any other collaborator, who, by adding to science,
has made his success in abdominal surgery possible.

But while all that pertains to the operation itself will of necessity
influence our successes and our failures in abdominal surgery, the treat-
ment before and after the operation are important factors in contribut-
ing to the results which astonish the world, and of which we, knowing
more truly their significance, may justly feel proud. Here, also,
the broad scientific knowledge of the day is perceptible, and of this
not so much talked of question I would ask your consideration, more
for the purpose of eliciting discussion and obtaining the views of
operators of more experience, than with the intention of advancing
either new opinions or adding to the well-nigh perfect methods now
practiced.

The treatment before an abdominal section will, it is scarcely neces-
sary to say, be in the direction of preventive medicine, and designed
to prepare the system against shock and to enable it during convalescence,
to continue the balancing between waste and repair which constitutes
normal functional activity. This is true of all operative surgery, but
becomes more especially so as the gravity of the case increases.

In this connection — the treatment before the operation — our atten-
tion is first directed to the organs of elimination, and of these the

106 Bureau of Surgery.

kidneys urge prior claimfe for consideration, not only because of the
function they perform, that of removing peculiarly poisonous material
from the swteni, but also because of the frequently masked diseases
that exist in these organs, and the developing or aggravating action which
sulphuricether exerts upon such diseases. In the light of recent investi-
gation, there is little doubt that some cases of sudden death during or
within a few days after an operation, are due to a defective action of the
kidneys, an action that in an undetected degree antidates the operation,
but probably as frequently is excited by the nervous condition that
precedes the operation, or by the ether used for anaesthesia. Shock
and uraemia resemble each other quite closely, and when the condition
of the kidneys is not known one may be mistaken for the other.

To ascertain the true condition of the kidneys it is necesssary to
examine the urine during several days before an operation, and for a
corresponding length of time after the operation. Probably if surgeons
would adopt this plan and make themselves more familiar with the gen-
eral condition of their patients th^ r would be better able to meet indi-
vidual complications as they arise, accidents in the operating room
would be less frequent, and the statistics of our graver operations would
be even more encouraging than they are at present.

The anaesthetic used, and the method of its administration are im-
portant factors in the before treatment of laparotomy. Of the two
anaesthetics, ether and chloroform, the former is regarded the safer.
This is certainly true, if we consider the suddeness with which the
lungs and heart cease to act under the less used vapor. There is no
question that a fatal dose of chloroform is more quickly and more
insidiously reached than one of ether : but in view of the known
effect of ether upon the blood, and upon the kidneys, has not our
rejection of chloroform been too general ? Should we not select our
anaesthetic in accordance with the condition of the patient? Where
there is suspicion of a kidney lesion would we not run less risk from
the general depression of chloroform than we encounter from the-
nephritic action of ether ? By careful watching, — one of the most
trustworthy signs of safe chloroform narcosis is to be found in the con-
dition of the pupil — we should be able to anticipate the stages of dan-
ger ; but if ether is given, and there is a kidney lesion, we not only run
the risk of accelerating that disease, but we possess no means of ascer-
taining the extent of the injury until after the injury has been done.
I do not wish to advocate the substitution of chloroform for ether in
abdominal surgery, but I believe that in some cases ether is, less free
from danger than chloroform. These cases may be few, they are cer-

Bureau of Subgery. 107

tainly exceptions, but their existence should cause us to hesitate before
subjecting our patients to an unnecessary danger, and one that could
possibly be avoided.

The defective oxygenation of the blood which ether causes, we may
conclude, is increased by the quantity of ether given, and will continue
in proportion to the length of time that a person is under its influence.
With the smothering method of administering ether, the minimum
quantity is less likely to be exceeded, than when the early stages
of anaesthesia are prolonged. From the former practice I have seen
no ill effects ; from the latter I have not been so fortunate. The
danger of both ether and chloroform, as of any other poison,
lies in the lithal dose, and when we recognize this fact, and regulate
our use of these powerful drugs accordingly, we will have fewer acci-
dents that can be traced to anaesthetics.

The fear that prevailed half a century ago of interfering with the
abdomen and its contents, has been replaced by the belief that the sur-
gery of this region of the body should be conducted upon the same
principles that govern operations generally. Thia rational conception
of abdominal surgery has developed a corresponding rational concep-
tion of its after treatment. The woman who has undergone abdom-
inal section is insured absolute rest for a few days. Her digestive
organs having been more or less disturbed, are given nothing to do for
twenty-four hours. At the expiration of that time, if there is no
nausea, the hot water is replaced by simple broth, or some form of
inilk food. I find that unadulterated milk is not always well borne
in abdominal surgery. It favors constipation, a condition to be avoided,
and gives rise to flatulence, a most distressing and dangerous complica-
tion. As a substitute for milk I have laterally used barley water diluted
with one-third cream with very gratifying results. At the end of
the first week, or possibly earlier, the patient generally receives easily
or partly digested semi-fluid food, gradually returning to her normal
diet.

Some difference of opinion exists among operators whose experience
is equally deserving of attention, concerning the treatment of the intes-
tinal canal after laparotomy. The former weight of opinion wad in
favor of enforcing a suspension of activity until convalescence became
fairly established ; the wisdom of this practice is now very generally
questioned, some surgeons advising the administration of a brisk
saline purgative on the third or fourth day after the operation. Each
surgeon must, to a certain extent, think for himself, and practice his
own surgery, and while I do not criticise either the methods or results

108 , BtTKBAU OF SUEOEBY.

of other operators, I am forced to say that I believe this interference
to be only exceptionally called for. Both theoretically and practically
I find no reason for denying the intestinal canal the same rest that we
seek to give other parts of the system. If the bowels have been
thoroughly emptied before the operation, — and the length of time nec-
essary to accomplish this will surprise one, — the food for the first few
days cannot leave any troublesome residuum in the intestinal canal.
Why then should we be so eager to force it into activity ? Mr. Tait,
one of the advocates of this practice, says, to drain the abdominal
cavity. It may serve that purpose in his hands. But when the opera-
tion is of such a nature as to require drainage is it not better to pro-
vide a mechanical exit for the fluid, than to throw unnecessary work
upon the peritoneum and the abdominal organs ? Best is one of the
elements of repair, and as a routine practice I have never seen occa-
sion for so early disturbing the inaction of the bowels that usually
follows a laparotomy. If peritonitis threaten, with distention of the
abdomen, a purge, especially calomel, will, by acting upon the portal
system, do much towards averting the threatened danger, but we would
then be dealing with quite another question from that of simply mov-
ing the bowels. If, in a week or ten days, the diet then being quite
liberal and containing solid food, there is no disposition to stool, an
enema may be given and repeated until effective, but I do not believe
in the efficacy of inducing a purgative action of the bowels in ordi-
nary cases of laparotomy. One of the most alarming cases I have ever
had, developed within a few hours after administering a purge. The
lady, — it was a case of hysterotomy, — was doing well, but on the
fourth day, the bowels being inactive, I ordered a mild purge. The
result was collapse, followed by peritonitis, and a prolonged convales-
cence, which I think could have been avoided. It is desirable to pre-
vent any great accumulation in the intestines, but the food taken is of
such a digestible character that this is not likely to occur within the
first week or ten days.

The management of flatulence, one of the most constant, troublesome
and in some instances dmgerous complications of abdominal section,
will sometimes tax our utmost skill. In a great measure the diet for
the first forty-eight hours will help to control this symptom ; we can
scarcely expect to prevent it. Hot water given ad libitum, sometimes
in sufficient quantities to cause emesis, is of service. It is a mistake to
leave the stomach entirely empty, for this condition in itself is suffi-
cient to generate flatulence.

Bureau of Subgsbt. 109

Change of position will frequently relieve flatulent accumulation.
Turning from one side to the other, or from the back to the side, will
not only relieve the colic, but liberate the gas. There is nothing in the
operation of laparotomy that should prevent a patient from assuming
any position that conduces to her comfort, or to change her position, —
of course with assistance, — as often as she feels the desire to do so. In
simple cases, the bed rest affords marked relief; I have allowed
patients to sit in a half reclining position as early as the third day
after the operation. Among medicines to relieve flatulence, Bella-
donna, Colocynth, Colchicum and Nux. vom. are invaluable. The latter,
I have found to give prompt relief. The rectal tube, worn for a length
of time, must not be neglected, nor the efficacy of enemas forgotten.
When the gas seems to be generated in the stomach, a soft oesophagael
bougia passed through the pyloric opening will afford temporary relief;
and this is important in severe cases.

The causes of flatulence after abdominal section are probably in a
measure nervous, it being one of the symptoms induced by the shock
which the system has sustained. I have found it developed to a distress-
ing degree after trachelorrhaphy, and perineorrhaphy, and several times
after a simple amputation of the breast. In such cases there is nothing
alarming in the condition, but when it follows upon an abdominal sec-
tion, the seat of the surgical lesion favors the development of serious
complications.

With the exception of the twenty-four hours succeeding a laparot-
omy, the bladder usually requires no active interference with its func-
tions. , The effect of ether upon the blood causes a degree of conges-
tion of the kidneys, which generally induces a temporary suspension of
their action. There is therefore not the usual quantity of urine
secreted. There is also frequently a spasm of the urinary sphincter,
which interferes with a voluntary emptying of the bladder. This state
of scanty urine, and inability to urinate, together with the importance
of ascertaining the condition of the kidneys, will of course be met by
catheterization, but as soon as the patient is able to urinate, she should
be allowed to do so. The practice of using the catheter at regular in-
tervals for several days, is, as a rule, quite unnecessary, and is liable to
give rise to a painful and troublesome form of cystitis. When an in-
ability to empty the bladder continues unduly, the u nervous spell" is
sometimes broken by allowing the patient to sit on the vessel in bed
once or twice ; after doing so, she is generally able to use the bed pan,
or urinal.

110 Bureau op Subgeby.

Nausea and vomiting are exceptionally absent after laparotomy, and
are as difficult to control. Since the use of the clamp has been re-
stricted almost entirely to hysterectomy, these symptoms have possibly
become less f reqnent, but they are still sufficiently common to prove
formidable obstacles to rapid recovery.

Apart from the general causes, disturbance of the abdominal viscera;
and nervous shock, I am led to believe that this very troublesome com-
plication is connected with the quantity of the anaesthetic given, and
with our method of dealing with adhesion. Of the former I have
already briefly spoken, but I will here add, that in general surgery I have
observed nausea and vomiting to follow more constantly and be more
persistent when Ether has been given slowly, than when the mini-
mum dose was administered. Though my opportunities for making
observations in abdominal surgery have necessarily been more limited,
I have here been led to the same conclusions, as those derived from
other operations.

The constriction of tissues within a ligature, is credited with causing
nausea and vomiting; when adhesions are numerous and are dealt
with in that way, the probability of exciting reflex nervous action, is
to that degree increased. Mr. Tait, who depends largely upon dry
sponging to control hemorrhage from pelvic adhesions, never using a
ligature unless absolutely necessary, says that nausea and vomiting are
rarely troublesome complications of his later laparotomies. May we
not therefore question, whether the ligature is not applied with unnec-
essary frequency, to abdominal adhesions ? Dry sponging and a more
frequent use of the actual cautery, would lesson the number of liga-
tures necessary to control hemorrhage ; and if these are a cause of nau-
sea and vomiting, would it not be well, when possible, to use other
means to accomplish the same end ?

In the removal of uterine fibroids, and in amputation of the uterns
itself, Mr. Baker Brown, and more recently Dr. Keith, have demon-
strated that the power of the actual cautery to control hemorrhage
may be depended upon. The vessels cut in the former operation,
especially those which enter into the pedicle, are large, but generally
have little contractile power, the blood therefore flows, rather than
spurts from them. In consequence, the eschar has not so much force
to resist, as from the same sized vessel in other neoplasms.

In a recent laparotomy for the removal of a sub-serous fibroid, I had
an opportunity to test the power of the cautery to control the character
of hemorrhage of which I have spoken. I tied the pedicle, which was
short and thick, with a Staffordshire knot, intending to close it over

Bureau of Surgery. Ill

with peritoneum, but almost immediately after cutting off the tumor,
the pedicle retracted, leaving a depression in the uterus, from the base
of which two large arteries poured out an alarming quantity of blood.
It was impossible to ligate the vessels, and any attempt to close the
uterine wound resulted in more laceration, and increased the hemor-
rhage. I applied the Paqnelin cautery, producing a large eschar,
with the effect of promptly controlling the hemorrhage. The case
progressed uninterruptedly to a perfect cure.

Frequent sips of hot water, 6eem not only to prevent, but to relieve
nausda. When there is constant vomiting, it may bo well to administer
large quantities of water and produce very copious emesis, to relieve
the irritation of the continued fruitless contraction of the stomach. I
have never seen any advantage from an admixture of brandy with the
hot water. The remedies given are numerous. I think I have had
the best results from a 2 percent, of Cocaine. Sometimes nausea will
persist until the clamp is loosened, or the deep abdominal stitches
removed. The truth is, nausea and vomiting are among the bete
noirs of abdominal surgery, and every case that proves obstinate to
treatment, must be studied individually, and step by step of the opera-
tion reviewed, to, if possible, ascertain the causes of the gastric dis-
turbance.

We now come to the question of using Morphine after a laparotomy.
In the early days of abdominal surgery it formed a constant part of
after treatment ; the most successful operators now use it sparingly,
and never unless the necessity for quiet and sleep are urgent. The
generally depressing effect of this salt, has led to its present restricted
use ; the wisdom of the change in practice can not be doubted. I have
not found that patients generally suffer acutely after they have fully
recovered from the anaesthetic. Their suffering is more from nervous
depression, and calls for a stimulant rather than for a depressant. If any
narcotiq is necessary, Opium will answer a better purpose than Mor-
phine, in abdominal surgery. Aconite and Hypericum, or the latter
alone, will relieve pain, and quiet the nervous system. After no oper-
ation do my patients receive Morphine, if they can possibly get along
without it, and they frequently do get along without it, by careful
nursing, and the use of Aconite and Hypericum. I do not wish to
oppose myself unconditionally to the use of Morphine in abdominal
surgery ; it is one of the greatest remedies that our materia medica
contains ; but in proportion as it is of use, it may be most harmful,
when indiscriminately given. Because a person has undergone a
severe operation, is not a sufficient excuse for giving Morphine. When

112 Bureau of Surgery.

they begin to suffer, and when they require quieting, will be early
enough to administer narcotics.

In this very brief consideration of the before and after treatment
of laparotomy, I have made no attempt to cover even the simple cases
of abdominal section. The complicated cases, and we know how fre-
quently these occur, must be met by all the skill and experience that the
operator can summon ; and notwithstanding these, and without apparent
reason, the result is sometimes failure. No branch of surgery is more
taxing upon the surgeon, none more unjustly criticised by laymen, and
in none should there exist more professional charity.

bromine as an antidote for dissecting

and septic Wounds.

By M. O. Terry, M. D.,

una*, n. y.

I have had poisoned fingers so many times and have been relieved
so speedily on these various occasions by the use of Bromine, that I
feel I shall be a Good Samaritan to surgeons wherever they may
reside, to the unfortunate physician, as well as to the student in the
dissecting room, if I re-impress this old remedy op your minds in a not
Unknown light, namely : its value as a remedy in poisoned wounds.

It has been considered valuable and used quite extensively in gangrene
and phlegmonous erysipelas.

Perhaps one of the most practical articles on the subject referred to
is that of Dr. Geo. Allen's, of Waterville, printed in Vol. XVIII of
the Transactions of this Society. But brevity is the soul of wit and I
wish to make this article so short, yet impressive, that it cannot be for-
gotten.

It was soon after I had been poisoned by operating on a malignant
case of diphtheria that I noticed the death of a prominent Brooklyn
surgeon, poisoned in the same manner.

This case, together with numerous ones of wounds which have come
under my notice, directly or indirectly, that were tedious in healing
and dangerous in character, has caused me to direct your attention to
a remedy of wonderful activity and reliability.

Bureau of Surgery. 113

You may theorize as you like in regard to how Bromine acts and why
it is superior to other agents like Carbolic acid or the cautery. It has
seemed to me, however, that its intrinsic worth depends principally on
two properties, namely : its power to penetrate tissues and to coagulate
albuminoids in a thoroughly antiseptic manner. It not only, therefore,
forms a coating over the poisoned surface of the wound, but destroys
the germs of the diseased part. It has another characteristic — it arrests
the inflammatory action, the abnormal heat disappears and with it the
pain.

Bromine should always be kept in solution in a glass stoppled bottle
in the surgeon's office. It can be prepared in the following manner :
Into an eight ounce bottle put about a drachm of Iodide or Bromide
of Potash, one ounce of pure Bromine and then fill with water. When
necessary to use it — for a poisoned finger for instance — pour about a
drachm into a glass and fill one-third with water. Insert finger for
some distance beyond the wound for a few moments and repeat every
three or four hours. Occasionally one application is sufficient. No
surgical dressing is necessary.

WIRING THE PATELLA. TWO OPERATIONS ON

THE SAME PATIENT.

By Sidney F. Wilcox, M. D.,

NEW YORK CITY.

The operation of wiring the patella has not been looked upon as one
giving the most brilliant results. The old superstition regarding the
danger of opening the knee joint, like that of opening the abdomen,
has not yet died out. The fear of setting up a suppurative inflamma-
tion in this large joint, and the consequent bad results which may fol-
low, still exists. But with thoroughly antiseptic methods it has been
demonstrated that the knee joint is as tolerant of operative interfer-
ence as any other portion of the body.

If I had no other ground on which to base my opinion, a certain
experience in operating upon this joint would make me a thorough
convert to the " antiseptic method" By this I mean antisepsis thor-
oughly carried out without omitting the slightest detail, either in the

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&*>'•■ ,' 11* Bureau of Surgery.

preparation for, or the performance of, an operation. Also I must
insist, to make my ground sure, that not only the operator, but also
his assistants, must exercise the most scrupulous care to the end of abso-
lute asepsis.

Still even under Lister himself, there has been one unsuccessful case,
and even with the best of favoHtble conditions, one cannot promise
perfect immunity from danger.

The majority opinion with regard to this operation may be briefly
stated as follows : That on account of the good results as regards useful
limbs under conservative methods of treatment, it is, as a rule, unneces-
sary to employ an operation which may be fraught with danger.

The exceptions to this rule may be : 1st. Where there is a compound
fracture with an opening into the joint. 2nd. Where there is a com-
minuted fracture to such an extent that it is impossible to draw the
fragments together by external means. 3d. Where there is so much
laceration or contusion of the tissues about the joint that external
means cannot be employed, and 4th, where, by the conservative meth-
ods, only a weak or inefficient ligamentous union has been obtained.
To this last class belongs the case which 1 shall detail.

The safety of a secondary operation is greatly enhanced by taking
advantage of a fact, noticed by Dr. Van der Meulen, a that in the
space between the two fragments of a broken patella, a clot of blood
is formed. This clot is not organized at once in its entirety, but the
anterior and posterior surfaces are first organized, and only after some
time does the process involve the central portion. In this way the two
fragments come to be united by two thin pseudo-membranes."

The author takes advantage of this in his treatment of fractured
patella. From ten to twenty days after the injury, he proceeds to
operate. An incision having been made over the patella, the anterior
membrane and the unorganized coagulum lying beneath it are removed ;
but the posterior membrane is not interfered with, and thus the joint
is not opened. The fragments are then united by platinum or silver
wire suture, care being taken not to include the membrane of organ-
ized coagulum, but to let it fold upon itself posteriorly towards the
joint cavity. Dr. Van der Meulen has operated in this manner in three
cases of fractured patella, and has been enabled to obtain excellent and
firm union.

(Medical Record, September 6, 1884, abstract from Deutsche Medi
cinal Zeitung.)

This operation of Dr. Van der Meulen's is of great practical value
in a secondary operation, as the actual opening of the joint cavity may

. ». _, .— . i -

Bureau of Surgeby. 115

be avoided. This I found to be true, for in the case I am about to
relate, I found that by carefully removing the bone from the articular
cartilage, a membrane was left continuous with this cartilage, stretch-
ing from one fragment to the other and covering the joint.

In the first operation this membrane was nicked through in one or
two places, but without giving rise to any bad result, as the record will
show.

Case, Mrs. C, set. about forty-five; widow; a very large stout
woman.

History — On May 15, 1886, slipped while coming down stairs. Sent
for her physician, who diagnosed rupture of the tendon from the right
patella. Treated with plaster of Paris bandage and was able to attend
to her household duties after a few weeks, until August 15, 1886,
when she slipped and fractured patella of the opposite (left) limb.
This was also treated with plaster of Paris bandage by the same phy-
sician, and after several weeks, he insisted on her attempting to walk,
supported by himself and her sister. On attempting to sit down after
the trial, the right patella broke the second time, and was treated for
two months by confinement in a plaster of Paris splint, when, becom-
ing dissatisfied, she had it removed and called in Dr. C. A. Walters, of
Green Point, who found the joint in a highly inflamed condition from
the splint.

Dr. Walters did not think a useful union could be obtained but
attempted it, after reducing the inflammation, but without result other
than a weak ligamentous union ; and in April he asked me to oper-
ate on her at the Hahnemann Hospital. She entered the hospital on
the 2l8t of April of the present year, and on examination I found that
she was entirely unable to walk or to stand on account of the weak,
thin, ligamentous union of the fragments on both sides. She remained
with the limbs constantly extended, and the least attempt at flexion
caused her pain and great terror for fear of a re-separation of the frag-
ments. There was a depression sufficiently wide and deep in either
patella to lay one's finger in, and so far as any power of locomotion
was concerned the woman was entirely helpless.

The first operation was performed on April 22, 1887, and the second
on the 23d of May.

As the method of operating on both limbs was essentially the same,
one description wjll serve for both.

The day previous to the operation I went to the hospital, selected
my instruments, and placed them in the pans on the operating table.
About a dozen towels and a piece of rubber tissue were placed in a

116 BtJBEAU OF SuBGEBY.

basin of 1-1500 solution of Corrosive sublimate and allowed to remain
soaking over night. About an hour before the operation, the instru-
ments in the pans were covered with a 1-40 solution of Carbolic acid.
The patient's limb was well scrubbed with soap and a solution of Cor-
rosive sublimate, and shaved before the operation. After the patient
was thoroughly anaesthetized, some of the towels which had been soak-
ing in the solution before mentioned were spread on the table, over
the opposite limb and over the limb to be operated upon, except about
where the incision was to be made.

The incision was semi-lunar, running from one side to the other,
about three inches in length, and running about $ of an inch below
the point of fracture. This was made in this way to get more room
and also that the cicatrix would not come directly over the line of
union in the bone. The flap was dissected back sufficiently so that the
patella could be raised with a strong vnlsellum forceps. A track was
made for the saw through the periosteum, and the bone being raised,
a thin shaving was sawn from the upper edge of the lower fragment,
being very careful to divide only the osseous tissue with the saw, but
not to go into the joint, the bone being carefully removed, leaving the
membrane on its under surface intact. A shaving was removed from
the upper fragment in the same manner. All this time, and during
the subsequent steps of the operation, an almost constant irrigation of
the wound was kept up with a Bichloride of Mercury solution
1-2000, the sponges being used but very little.

Three holes were drilled in each fragment. These began from
i to $ of an inch back from the sawn edge and ran obliquely down
to, but not through the articular cartilage. The wires were then
passed through the corresponding holes in the two fragments,
and with a strong pair of toothed forceps the fragments were
brought into apposition. This was much more difficult than would
be supposed, as the quadriceps having become somewhat contracted
owing to the lengthening of the tendon, had now to be practically
overstretched. Another difficulty was found in bringing the sawn
surfaces into exact apposition on account of an obstinate tendency to
tilt. However, this was accomplished, the wires were twisted as
tightly as they would bear, and the ends cut off short and tucked
down along the line of union, and covered over by the periosteum.
The wire was of pure silver and in the second operation as thick as
an ordinary probe. Two rubber drainage tubes were placed at the
angles of the wound, and the flaps brought down and fastened by
three button sutures and the edges more closely approximated with

Bureau of Subgeby. lit

catgut, sutures. Iodoform was then dredged on thickly, covering
the incision and the ends of the tubes. The dressing of borated cot-
ton in layers of corrosive sublimate gauze was then applied, and
over this a sheet of the rubber tissue which had been soaking in the
solution, and the whole held in place by a roller bandage. Then a
plaster of Paris bandage was applied from just above the malleoli to
well up on the thigh, leaving an open space over the wound for inspec-
tion. Before application the rollers containing the plaster of Paris
were wet in the Bichloride solution instead of plain water. After
this had set, the patient was put to bed.

For the first day or so after each operation, there was a little serous
oozing which passed through the plaster on the under surface, and I
directed the nurse to daub on more plaster wet with the Bichloride
solution 1-1500, several times a day until the oozing stopped, which
it soon did. »

There was nothing after either operation calling for any special
attention. The highest temperature was 100.5° Fah., which was on
the day succeeding the first operation. The dressings were not opened
until the sixteenth day, and then only for removal of the rubber tubes
and button sutures. No pus was found on the dressings — only dried
serum. In the first wound, owing to the not exact coaptation of the
integument, there was a little raised point of superabundant granula-
tion. This was snipped off and touched with Nitrate of Silver
once* or twice, and gave no further trouble. Aside from this, both
wounds healed perfectly by first intention. The plaster of Paris
splints were retained in position for six or seven weeks, until I was
certain that union had taken place.

The patient remained in the hospital until the middle of August,
when she was discharged cured. She had not then walked on account
of the nervous fear of refracture. At that time the wounds were
perfectly healed, both patellae were movable, the cicatrices non-adher-
ent, and she could flex the legs in the thighs to a few degrees.

In this paper I have made no attempt at gathering statistics or quot-
ing opinions ; this has already been done by others, and the operation
has a recognized standing.

The points I wish especially to draw attention to are : 1st, the fact
of the existence of the two layers of ligamentous connection between
the fragments, as shown by Dr. Van der Meulen ; and 2d, the good
result of a thorough application of the antiseptic method. Although
the joint was opened in the first operation, no trouble followed, and
I challenge anyone to open the knee joint without antiseptic precau-

<^-

I 5 **

A' .

ft* 1

.»

118 Bureau of Surgery.

v tions, and not have it followed by either pus formation or a decided
rise of temperature. Indeed, as was significantly pointed out by Dr.
F. C. Fuller, in an article on the subject, the men who favored this
i * as a primary operation were those practicing the antiseptic method,

while those who opposed the operation and considered it dangerous,
were opponents to antisepsis.

CAESARIAN SECTION.

By Prof. H. F. Biggar, M. D.,

CLEVELAND, O.

Mrs. Salter, aged 28, the wife of a coal miner living at Salineville,
O., four feet in height, usual weight sixty-five pounds ; a patient of
Dr. J. A. Sapp of the same place. This is her fourth impregnation,
the former three going to full term and each in succession being
destroyed in utero. It was the wish of the parents to have^a living
child, so a few days previous to this last confinement she was sent to
Huron Street Hospital.

Labor began in the morning of December 16. Her case was care-
fully watched by Prof. J. C. Sanders, Drs. J. A. and L. W. Sapp and
Myra K. Merrick. Before completion of first stage of labor, in con-
sultation with the above doctors, it was decided to perform the
Caesarian section, the deformity of the pelvis warranting such an
operation. At 9 o'clock in the evening of the same day,with the assist-
ance of the above and Drs. A. K. Smith and J. Kent Sanders, the
operation was performed.

An incision, extending from the umbilicus to a line above the
symphisis pubis, was made down to the uterus, which was then
firmly fixed. An incision in the uterus was made six inches in
length, and the child quickly removed with the afterbirth, the uterus
being grasped to assist contraction. Eight deep sutures of catgut
and eight superficial completed the uterine operation. No fluid was
allowed to get into the abdomen, which was closed with silk sutures,
and a drainage tube inserted through the neck of the womb into the
vagina. No unpleasant symptoms arose during convalescence.

The treatment locally used was Calendula and Glycerine in the pro-
portion of one to eight, the main remedy being Arsenicum.

The mother and child returned home within a month after the
operation, and up to the present are well.

Bureau of Surgery. 119

PISCUSSION.

(radical cure of hernia.)

Dr. Van Denburg : I would like to ask whether it is definitely
known that the mesentery was shortened by Lycopodium ?

Dr. Lee : I will say that Prof. Gilchrist, who wrote the article on
hernia for Arndt's System of Medicine, states clearly there that Lye. is
used on clinical indications. It is a remedy that has been spoken of
by a number of our writers as being a good agent for hernia where
there is gaseous distension.

Dr. Boocock : Dr. Thompson, of England, experimented on Lyco-
podium some time ago as to how we obtained its medicinal property.
He states that there is no benefit obtained until after the 6 dec. The
powder, when seen under the microscope, is a fine nut, and it is broken
only as he gets to the 3rd and 6 dec. He gets the medicinal property
by transmitting the sugar through ether, and so he gets an oily matter
which is the medicinal property. We don't get Lycopodium below
the 6 dec, but above it we do. Those of us who have tried it know
we get no result of Lycopodium below the 6 dec. I use it very fre-
quently for the extended gaseous condition of the abdomen and
always receive prompt results. I recently had a case — crural hernia with
peritonitis — which passed through my hands, which has been cured by
medicine without surgery. The man was on his back for two
weeks and I never saw a case of greater inflammation ; peritonitis was
supreme, and the pain caused by the inflatfon of the bowels by the gas
was very great. It was removed by Lycopodium 6th. The man is up
now and apparently well.

Dr. Van Denburg : I do not see that it is anything more than an
inference. I understand it to be stated as a fact. I do not think the
proofs are sufficient to warrant such statement. Nothing short of a
port- mortem could prove that, and even this might leave a doubt. Let
us be as exact as possible and not claim more than the premises admit.
These loose inferences are those that deteriorate our observations. We
may grant that the hernia disappeared, but not assign the cause as more
than inferential until more conclusive proof.

Dr. Wiloox : I have operated twice in the cases of hernia, where
1 just stitched through the sac at the neck, with large sized catgut and
then stitched this to the walls or sides of the ring by means of silver

120

Bureau of Surgery.

sutures, so that it was all fastened together and then the sac was cut off
close to the portion where I stitched the membranes together. The
after treatment differed a little from Dr. Gilchrist's, because I used a
different dressing, and in such a manner that I could leave my dressings
in place for a week.

Dr. Lee : This is the paper of Prof. Gilchrist and not my own. I
give it as his opinion, and he states, in the last clause of his paper :
" There can be no doubt that the shortening of the mesentery is caused
by giving Lye."

(wiring the patella).

Dr. Boooook : I would like to ask the doctor whether he used any
internal medication ?

Dr. Wilcox : I employed a little medication and only to remove
the pain. I think after the second operation, where the fragments
were further apart than in the first, on account of the extreme tension
on quadriceps muscle, a small hypodermic of Morphine was given.
No other medicine was necessary.

Dr. Boooock : The object of my asking was to find whether the
bones were needed to be united quickly. I have , had two or three
cases which united very promptly under the influence of Calc. phos.
so you could feel the deposit of the lime round the broken part
from the outside, and the bone united so quickly that it is worthy
of note.

Some years ago I had a case come into my hands out of the hands
of Dr. Megs. A fracture of the fibula, which, after six months, was
still without union. The woman could go about on crutches, carrying
her leg in a sling, but could not under any cirenmstances bear to touch
the ground with it. In this condition I found her, the leg very much
swollen, the crepitation of the bone could be heard distinctly. I gave
her Calc. phos. 6th dec. three times dailyand told her to eat plenty of
cabbage and any kind of vegetables. In three weeks she could step
with the lame foot.

Dr. von Grauvogl tells of an aged officer in the Prussian army,
whose broken leg had been stretched until he had one additional joint
in it but no power to walk. He was entirely restored, the additional
joint hardened under Calc. phos. and the fracture was cured. From
the end of the broken bone exudes a fluid, which in time will harden.
Calc. phos. quickens this hardening process and so shortens the time of
the cure.

&■

Bureau of Surgery. 121

Dr. Lee : It is well known that I take no stock in antiseptics.
New York is a dirty place, and it may be needful to use them here,
but not in a cleanly little town like Rochester.

Dr. Wilcox : I am a thorough believer in antiseptics, as I said
before, and so strong is my belief that I feel absolutely afraid to do
any operation of magnitude without it. If I opened a knee joint and
anything happened ; if I had suppuration, or the patient had pyaemia,
as in a case reported in the Medical Record some time ago, if such a
result should happen and I had not employed the strictest antiseptic
methods I should feel criminally responsible. The importance of
antiseptics is recognized by the governments of Europe, where anti-
septic practice is enforced; it is recognized in the courts, where a
surgeon not treating a wound with an antiseptic has been considered
guilty of malpractice. In my own experience, (though perhaps not as
extensive as that of Dr. Lee), I have seen and treated a good many
wounds where we used to be as careful and cleanly as anyone could
be without especial antiseptics. Take, for instance, an amputation of the
breast, the wound was dressed twice a day, but the pus ran out and the
odor filled the room, and the patient always had a high fever, careful
as one might be. Now I don't ordinarily dress a wound under two
weeks, and 1 don't think I am less cleanly. There is something in the
method ; it stops the suppurative process ; it prevents the patient hav-
ing the high fever he used to have, and enables us to do with impunity
now what we did not dare to do years ago.

Dr. Lee : Dr. "Wilcox defies any one to open the knee-joint and
have the wound heal without suppuration where antiseptics are not
used. I have opened the knee-joint three times during the last two
years and plain dressings were employed in all of the cases. The
wounds healed with no suppuration except in one case. This was a
gun-shot wound. The bullet passed into the joint just below the inner
border of the patella, and was embedded deep between the cartilages.
A rather long incision had to be made to extract the missile. This was
attended by suppuration and high rise of temperature, from which he
recovered in three or four weeks with a perfect leg.

Gentlemen, I do not believe that we know much about germs ; cer-
tainly we do not know, at the present, that they are the cause of disease;
quite the contrary, they are probably the result of disease ; God's scav-
engers and nothing worse.

I believe with those great German surgeons who were led to exclaim
in one of their conventions across the water, when Keith made his

122 Bubeau of Surgery. x

report of wonderful success without antiseptics : " Mine Gott, Lister-
ism ist todt! Fort mit dein spray." I believe that Listerisra is dead;
that all the good antiseptic practice has accomplished is to teach the
profession that the details earlier considered of little consequence, like
perfect cleanliness, drainage of wounds, the use of absorbable ligatures,
and an hundred other little points, are of paramount importance. It is
the observance of these little things, with increased skill in operating,
which has brought surgery to its almost wonderful state of perfection,
and not these poisons.

Dr. H. I. Ostrom : I cannot agree with Dr. Lee in his denouncia-
tion of antiseptics in abdominal surgery. I use strict antiseptic meth-
ods in all my abdominal sections, and I have yet to meet with my first
case of poisoning from such practice. I have used very hot water to
flush the abdominal cavity only once. It was a case of shock, during
an unusually difficult ovariotomy. I filled the abdomen with hot
water, and I think by so doing assisted to overcome the extreme
depression, which developed without the common indications of danger.

Dr. Boocock : Very often, in our whole treatment of these injuries,
wounds, etc., in private practice and at the bedside, we have no
chance for antiseptics ; and in surgery wards in the hospital it seems
almost impossible to do without them.

(the before and after treatment of laparotomy.)

Dr. Lee : I did not notice the mention of the usefulness of hot
water in profound shock and to check hemorrhage resulting from
separation of adhesions. The operator will occasionally run across a
case that will result in shock, and for a time it may seem that the
patient will die. The best remedy is to fill the abdomen full of water
at a temperature of about 110° ; then use your other helps with it.

These antiseptic fellows are anxious to " do me up ;" they are here
in force, and should be allowed to air their germs a little.

Dr. Wilcox : I have never vet seen a case of Corrosive sublimate
poison, and have used it without stint. I use Iodoform on granulat-
ing wounds, and have never had the slightest bad result afterwards. I
have never seen the slightest deleterious result from the use of Carbolic
acid. I don't believe in using Corrosive sublimate solutions too strong,
one to five hundred, as surgeons did use it at first .There seems to
be a certain condition in which patients are especially susceptible to
the action of Corrosive sublimate solution, and that is after confinement,
where irrigations have been used containing Corrosive sublimate,
and where they seem to be especially susceptible to its poisonous influ-

Bureau of Subgeby. 123

ence, and a few bad results have been given ; but otherwise, I have
never heard anything bad with the solution in the strength ordinarily
used. In the cases where poisoning has been reported, very strong
solutions were used.

Db. Lee : The doctor is wonderfully ignorant on the subject. I
am surprised that a gentlemen of his learning should not know that
the back files of many of the journals published in Europe and Amer-
ica are teeming with reports of deaths from the use of the various
agents to destroy germs. The Mercuric bichloride unites with the albu-
men of the tissues and forms an albuminate of mercury and is per-
fectly inert. It is not until this agent is used in the proportion of one
to four hundred that it will destroy the bacteria and then it does the
work by killing the patient as well.

Db. S. H. Knioht : I never did an abdominal section myself, but
during the last two years have assisted several different surgeons in
this city in some forty cases, and after the operations have had
charge of the treatment. So I am somewhat familiar with the methods
pursued and the complications that may arise. These cases include
various operations, from a simple exploratory incision to double ovarioto-
mies and hysterectomies. In all these cases jether was the anaesthetic.
I believe in giving patients as little ether as possible. Simply keep
them quiet, and even allow them to partially recover consciousness once
or twice. I have never seen any bad effects from the ether. Twenty
minutes before giving the ether give a hypodermic of Morph. sulph.
£ gr. and AtropifiB sulph. yfoj- gr.

For the first twelve or twenty-four hours nothing but ice or rice-water
is allowed the patient in the way of nourishment. After that milk,
diluted one-half or one-third, may be given in small quantities at fre-
qnent intervals. No animal food is allowed before the seventh day.
Any attempt to substitute this for milk diet too early has always been
regretted. Gradually from this the patient receives a full diet.

In the treatment of abdominal flatulence I find Lycopod. the best
remedy. Its action is sometimes really wonderful. I remember one
case, a hysterectomy, in which there occurred a stoppage of the bowels,
causing matters to look very serious. Lycop. was the only remedy
used, and in forty-eight hours gas passed freely and there was no
further trouble.

If patients crave tea, even on first day, I allow them to have it. I
have seen it relieve vomiting which had persisted for days and resisted
all remedies.

BOBEAO OF SuBGEBY.

we need not bother about the bowels for seven or eight
rive them at night an enema of oil, another in the morning,
it up in three or four hours with one of warm water. After
Belladonna, or some indicated remedy will generally suffice,
eparation of Malt with Cascara is very good.
lilting, I think it the hardest symptom to combat. , It
think, partly on the individuality of the patient and partly
everity of the operation, together with the anEesthetic
ends upon the ligatures used in the operation hardly seems
or I have seen cases where there were many adhesions
igation, and again cases of supra-pubic hysterectomy where
rubber ligature wound tightly about the uterns itself, with
vomiting. In those cases where the rubber ligature was
removal of a fibroid tumor, though there might be a pro-
phage from the tumor itself, yet not a drop of blood escaped
idicle. Veratrum alb. and Arsenicum are the best reme-
ttinate vomiting.

, on the whole, the wire stitch is the best. It gives some
removed but they can be quickly iutroduced (and time is

through skin, muscle and peritoneum and then easily

operations are done antiseptically. For sponges, flannels,
> into the abdominal cavity we use the Bi-chloride mercury
35000. In a few cases we have tried pnre water and had no

eliever in antiseptics.

Antiseptics are stylish ; there are styles in millinery,
jss of every kind, and styles in surgery, which are the most
f all. Gentlemen, I feel that the law should hold me culpa-
lould employ Mercury, Carbolic acid, or any other poison
i patient a victim of their toxic influence. And I claim
of death any court ought to hold a surgeon accountable
oduction of such rank poisons, into clean wounds.

REPORT

OF THE

BUREAU OF OPHTHALMOLOGY.

A. B. Norton, M. D., Chairman^ - - - New York City.

Drs. Wm. P. Fowler, Rochester.

John L. Moffat, Brooklyn.

N. L. McBbide, New York City.

Chas. C. Boyle, New York City.

Disputants : Drs. Geo. S. Norton, - - New York City.

F. H. Boynton, - New York City.

SPECTACLES.

By Charles Deady, M. D.,

NEW YORK.

To a large majority of the general public, the fitting of spectacles
is an exceedingly simple matter, it being only necessary to look over the
stock of some vender of the article, (often a traveling peddler) and
select what seems to be about the thing ; the whole business being
transacted in much the same fashion as would be the case in the pur-
chase of a barrel of flour or a cord of wood. It is unnecessary to
inform the intelligent physician that this is all wrong, but few realize,
even in the medical profession, what a momentous matter the choice
of spectacles may be under certain conditions.

At the present time, in our large cities, much of this business is in
the hands of reliable opticians, who have a fair knowledge of what is
required in ordinary cases, and many of whom are sufficiently consci-
entious to refer the patient to an oculist when they are in any doubt.

ifcf. v .

► ■ V '

126 Bureau of Ophthalmology.

Even under these, the most favorable conditions, the experiment is
often ill-advised, as of course no optician takes into consideration pos-
sible irritability or spasm of the ciliary muscle, the disturbance of
equilibrium in the action of the recti muscles, or the not infrequent
, intraocular complications, only to be discovered by an examination with
the ophthalmoscope.

If we deprecate the fitting of glasses by the educated optician, who
at least understands the optical necessities, what must be thought of
the village jeweler and the itinerant " professor " who are in many
cases too ignorant to ascertain the number of a glass, except by its label
(which is generally wrong) and who sell to a confiding public their
" diamond pebble," " opal tinted," " medicated " spectacles at the low
price of $9.00 per pair — cost thirty-four cents each by the gross.

The injury which may result from the interference of these med-
dlers becomes, in a certain class of cases, so great as to almost war-
want us in charging them with criminal ignorance. Who among ocu-
lists has not seen cases of progressive myopia which have been
" fitted " with glasses in this manner until the patient was almost blind ?
How many patients with intraocular disease are despoiled of precious
time by delaying their visit to a competent physician until they have
tried the various glasses offered for sale in their neighborhood ?

In purchasing glasses haphazard the patient becomes his own judge
as to the fitness of the selection, and as a matter of fact his judgment
is a very poor one to rely upon. The correct rule in prescribing glasses
for myopia, or near sight, is that the weakest glass which enables the
patient to see distinctly should be given. Now An practice we find that
the patient, if left to himself, will almost invariably choose too strong
a glass, because he gets a brighter picture with it. Again — unless my-
opia is high in degree, the patient is usually aj)le to read without any
glass, and prefers to do so. Nevertheless it is often necessary to give
such patients not only a glass for distance, but another for reading —
not to make reading easier, but to make them hold the book farther off
and thus prevent undue convergence.

In hyperopia, or far sight, the rule is to give the strongest glass,
which, while fulfilling certain conditions, can be worn with comfort.
In a large number of cases patients purchase instead the weakest glass
they can get along with, on the old theory that by delaying the use of
glasses as long as possible and by using the weakest number that will
accomplish the work, the preservation of sight is guaranteed for the
longest period.

^^Ila l

If"

Bureau of Ophthalmology. 127

In cases of spasm of the accommodation, we often have apparent myopia
with actual hyperopia. No examination, as practiced by even the best
optician, will reveal this state of affairs, as it cannot be detected without
a careful examination with the ophthalmascope unless Atropine be used.
If such a patient choose his own glasses he will naturally select a con-
cave lens, whereas his condition of refraction requires a convex one.
The writer has recently treated precisely such a case, in which a hyper-
opic patient with spasm endured a concave glass of considerable
strength for over a year, at the expense of much discomfort.

Where spasm complicates myopia, the latter is apparently increased,
and the patient requires a stronger concave lens to see distinctly than
the myopia alone would call for ; if he obtain it the difficulty becomes
the more obstinate, and the actual myopia often becomes progressive.
These are the cases where spectacles are like edged tools, to be handled
safely only by educated skill.

In cases of astigmatism, the refraction in one principal meridian of
the eye differing from that in the other, the oculist is usually consulted
after a series of unsatisfactory experiments with all kinds of glasses*
each of which seemed to be the thing for a short time.

The question as to whether spectacles or eye glasses should be worn
is frequently asked by patients. The answer must depend on the charac-
ter of the case. In many cases the shape of the nose renders it
exceedingly difficult to retain the eye-glass in position ; often where the
physical conformation is all that could be desired, the pressure of the
spring causes a disagreeable drawing sensation in the eyes, which not
only causes much discomfort, but in some instances causes reflex ner-
vous symptoms. These conditions, however, are so troublesome to the
patient that they generally result in a change to spectacles before any
harm is done.

One principal objection to the eye-glass is the fact that its relation
to the eye is not a constant one, it is a common habit to place the eye
glass upon the nose at varying distances from the eyes and at almost
any angle with the face. If the lens be of short focus a considerable
difference in its power may result from changes in its position. If a
spherical lens be tilted sufficiently it becomes virtually a cyclindrical
lens. Astigmatic patients who are not aware of their defect, and are
wearing spherical glasses, sometimes make use of this fact, as they dis-
cover by experience, that vision is improved by tilting the glass to a
certain angle. It is a common and careless habit among others. In
cases of astigmatisms, where cylindrical lenses are prescribed, their use
in the form of an eye-glass is often unsatisfactory, because of the dif-

128 Bueeau of Ophthalmology.

ferenee in the inclination of the axes of the cylinders in one position
on the nose as compared with another. And also because the axes may
in time be permanently changed by weakening or bending of the
spring.

In certain cases, however, we may prefer eye glasses to spectacles.
Thus in myopia of a high degree, we wish to give our patient glasses
for such use only as may be actually necessary, fearing an increase of
the near sight if more be allowed. If we give such a patient specta-
cles the chances are that he will not take the trouble of removing
them. In cases of hyperopia or presbyopia where glasses are only
used for near visiou, the eye-glass is often preferable for the same
reason, especially among busy men whose occupations require that they
should use the eyes for near vision frequently for short periods.

Having decided that spectacles are necessary, there are several points
to be carefully attended to, for it is quite possible for a lens of the
proper strength to be so adjusted to the face that its use will be very
unsatisfactory and even painful.

The spectacle frame should not be too light. In the effort to reduce
weight the opposite extreme is often reached and the thinest kind of
wire is used. These glasses should be avoided, as they have not suffi-
cient strength to retain the original shape, and are apt to lose their
parallel relation to each other and to deviate from a correct centering.
The so-called " skeleton " glass without frame is often injurious, because
of the prismatic action of the edge of the lens, producing sometimes
a play of colors which is dazzling to weak eyes.

The lenses should be far enough from the face to clear the eyelashes
easily and no more. This is a very important matter in a strong concave
glass, less so in convex lenses. If the glasses are intended for reading,
they should tilt forward slightly, the plane of the glass in reading
should be the same as the plane of the printed page.

The center of the lenses should correspond with the position of the
pupils ; if a pair of convex lenses are set too far apart, the pupils
strike the glass to the inner side of its center and we get the effect of
looking through a pair of prisms with their bases outward, which is to
turn the eyes inward to an excessive degree, producing pain and mus-
cular weakness. It is especially necessary that the centers of the
lenses be of equal height, as the power of the superior and inferior
recti muscles is very slight as compared with the internal and external,
and a deviation in this direction may produce great discomfort, with-
out being very considerable in degree.

Bureau of Ophthalmology. 129

Where glasses are intended for near vision their centers should be
nearer the median line than for distance, as the eyes naturally con-
verge in looking at near objects. When correct lenses are prescribed
and all other requirements are satisfied, the result is usually all that
can be desired, while the failure to meet many of these conditions, in
glasses manufactured by the gross, is the cause of mnch visual weak-
ness and suffering.

CURATIVE EFFECT OF GELSEMIUM IN DISEASE

OF THE UVEAL TRACT.

By Chas. C. Boyle, M. D.,

NEW YORK.

Dr. Norton in his Ophthalmic Therapeutics says that " its action
npon the uveal tract is very marked, especially in the serous form of
inflammation." In this paper I wish to report the history of two cases
of disease of the eye involving the uveal tract that had been under
treatment by the old school oculists and pronounced incurable. These
cases were both treated and cured by the administration of Gelsemium
internally. One was a case of detachment of the retina in an eye con-
siderably myopic, and probably brought on by excessive use of the
eyes, myopia being one of the causes that tend to detachment of
the return. This patient had been under one of the best oculists in this
city, and was treated in his private hospital for over a month, being not
only confined to bed during that time with the eye bandaged but
besides had had paracentesis made through the choroid at the back
part of the eye to draw off the fluid between the retina and choroid.

All of these means failed and the man was finally discharged and
pronounced incurable. He then came to the New York Ophthalmic
Hospital to Dr. Geo. S. Norton's clinic, whose assistant I was at that
time. Dr. Norton being away, I advised the patient to come into the
hospital and stay for a month and see if he could be benefited. I
did not give him much encouragement, as the case had already
had good treatment, with the exception that Gelsemium had not
been given. This I explained to him, and told him I had seen
a case similar to his cured, but it had not been of so long stand-

130 Bubbau of Ophthalmology.

ing. He was willing to try and came into the hospital. The eye was
bandaged and the patient put to bed and kept on his back most of the
time. At the end of six weeks he was discharged cured with a vision
of $$, the loss of present vision being due to a slight posterior polar
cataract in both eyes, which he had had for some time. Afterwards
he had the pleasure of going back to his old-school friends and show-
ing them what we had done for him.

The other case is also one which Gelsemium cured after theold school
oculist had pronounced it incurable. A man sixty-five years old was sent
to me to be examined for his eyes by a society who were to pay him
some money on account of total blindness in one eye and partial in the
other. One eye had total detachment of the retina from an injury,
with entire loss of vision, and the other eye with a vision of $$ ; on
examining this eye with ophthalmoscope found vitreous cloudy and
filled with opacities. I gave a certificate to that effect and pronounced
him incurable, but before he left the office I questioned him in regard
to his treatment, and judged from his answers that it had been princi-
pally Iodide of Potash, which by the way is a very good remedy in
opacity of the vitreous. I then gave him a prescription for Tinct.
Gelsemium and told him to take three drops four times a day, but told
him I did not believe it would help him, but he might try it. I never
expected to see him again, but what was my surprise when he came to
my office, some three months after, asking me to fit his eye to a glass.
I told him no glass would help him, but however I would try, and
found his vision J# without glasses, and with a +0.75 D it was |f —
perfect vision. On examination with ophthalmoscope found vitreous
entirely cleared up.

As he had already received his money for blindness, I told him he
had better nQt say much about his restored sight. He said he had no
one to blame for it but me.

These cases will illustrate the advantage we have over our old school
friends in the treatment of diseases of the eye, not only in the troubles
spoken of above, but in all that the eye is subjected to, and at the
6ame time we employ the means which they depend on, such as rest,
bandaging, operations, or the use of Atropine when necessary to keep
pupils dilated to prevent adhesions.

Bureau of Ophthalmology. 131

EXTRACTS FROM CASE BOOK.

By E. H. Linnell, M. D.,

NORWICH, CONN.

Case I. Colocynth in Irido-choroiditis*

On the 5th of Jan., 1887, 1 was called to see Mrs. W., in consulta-
tation with Dr. B. I found her suffering with Irido-choroiditis serosa
of the left eye. She had been sick five weeks. The condition of the
eye, at the time of my visit, was as follows : Iris discolored and pupil
contracted. Slight pericorneal injection, especially in lower portion of
eye-ball. Slight cutting pains. Eye very sensitive to touch or
motion. T +1, vitreous filled with fine opacities preventing a view
of the fundus with the ophthalmoscope. Vision reduced to counting
fingers at 3 ft. I advised the use of a 1 per cent, solution of Atropine
sufficiently often to keep the pupil well dilated, and the use of Bry-
onia internally and the case was left in the hands of the family physi-
cian.

One week later I again saw the case in consultation. The pupil
was then dilated ad max above, but not quite as much below, and the
iris was still of a greenish hue, instead of the natural blue of the other
eye. The subjective symptoms were entirely relieved, but the condi-
tion of the fundus and the vision were unchanged, and the tension
was still a little increased. Iod. potass. l x was advised, together with
the instillation of Atropine 1 gr. to oz., n and m.

At my next visit, one week later, the iris was of normal color and
luster and there was no epi-scleral injection. The vitreous was less
cloudy, so that the optic disc and the retinal vessels could be dimly
made out, and there was a corresponding improvement of vision. The
same treatment was continued.

One week later there was still further improvement in the appear-
ance of the fundus and of the vision, although there was again some
sensitiveness of the eye, which I attributed to an unfavorable change
in the weather. The same treatment was continued with the addition
of a single dose of Sulp. 80 every second day.

Two days later there was a severe aggravation of the disease, and the
case was placed in my hands. Without apparent cause, there was
renewed iritis with severe pain and tenderness, increased cloudiness of

132 Bubeau op Ophthalmologt.

vitreous, and obscuration of vision. In fact the condition was as bad,
if not worse, than at any time previously. I was at a loss to account
for this sudden relapse, as the patient's general health was good, and
she had not, to my knowledge, been imprudent in any way. The
mystery was solved a few days later when she confessed to having
used a solution of Colocynth, (or bitter apple), in rum as a hair wash
just previous to the aggravation of the eye trouble. She had been in
the habit of using it frequently for a year or more, and I learned that
she had been subject to frequent attacks of colic which presented the
well known characteristics of Colocynth, and were controlled by that
remedy. I will not weary you with a further detailed report of the
case. Suffice it to say the hair wash was not used again and she made
a complete recovery in a reasonable time, and with no other remedies
than those previously used. Bryonia gave relief in the acute stage,
and Iod. potass, and later Sulph. cleared up the opacity of the vitreous
and restored normal vision.

I think we may fairly consider this case as aggravated, if not pri-
marily caused, by Colocynth. The drug is readily absorbed through
the skin, producing its specific effect upon the alimentary canal just as
when it is taken by the mouth. In the accounts of poisoning by this
drug we find that it produced obscuration of vision in one person,
and others report twitching of the upper lid of the right eye, and pain-
fulness of the eyes, increased by stooping. In the pathogenesis of the
drug we have developed the cutting and burning pains in the eye, and
the tearing and boring pains in the temple and side of the head, and in
the face. Dr. Watzke, of Vienna, who made a thorough proving of
the drug says : " The hemi-crani® and perso-palgiae which Colocynth
will cure are in all cases purely functional derangements of the tri-
facial nerve." Does experience bear out the truth of this statement ?

If my assumption is correct, that Colocynth caused in the case nar-
rated actual inflammation of the iris and choroid, it should be cura-
tive in similar inflammatory conditions, if there is any truth in our
therapeutic tenets. The following case is the only one that I can find
recorded where an organic affection of the eyes was cured by Colo-
cynth. The case is so imperfectly recorded as to leave us quite in the
dark as to the real nature of the disease, but it evidently was some-
thing more than trigeminal neuralgia.

" The patient had been afflicted for a considerable time with an
almost permanently existing headache, after which the eye became
inflamed. When Dr. S. was called the patient had already lost his sight.
In the right eye, the sight of which was still p*eserved, the patient

Bubeau of Ophthalmology. 133

complained of burning, cutting pains. Congestion of blood to th,e
head and discharge of acrid tears from both eyes troubled the patieut.
Two drops of the tincture of Colocynth every three hours removed the
headache in twenty-four hours and effected a considerable abatement
of the pains in the eyes. The continued use of Colocynth restored
the sight of both eyes completely in eight days, and effected a perfect
cure."

The pulp and seeds of the bitter apple contain a large amount of
mucilaginous matter which I suppose is the quality that recommends
it as a hair wash. I did not know that it was ever used for such a pur-
pose until Mrs. W. spoke of so using it, but I have since found it in
another family where I have frequently been called of late to prescribe
for attacks of colic. I do not know how commonly it is used in this
way, but I think we should do well to warn our patients of its poison-
ous properties as opportunity occurs.

Case II. Traumatic rupture of Iris and permanent Mydriasis,
without external wound.

Nov. 8th, 1886, Harry P was struck in the right eye with a

stone four days previously. The lids were closed for three days. Now
there is no external sign of injury either to lids or ball, but the pupil
is dilated nearly ad max. and there is a small rent in the pupillary bor-
der of the iris at the temporal side. T. — 1, no pain ; vision either
eye £# ; that of left made J$ + with — ^ , but glasses do not improve
vision of injured eye. The opthalmo&cope shows a little hyperemia
of the retina but no lesion is discoverable at the bottom of the eye-ball.
Prescribed Arnica internally and a solution of Atropine 1 gr. to the oz.,
to be instilled night and morning to still further dilate the pupil, and
prevent if possible the formation of adhesions between the torn edges
of the iris and the anterior surface of the lens.

Nov. 15th. Vision increased to {$. Retinal veins a little swollen
and retina in vicinity of disc a little hazy. Discontinue Atropine, con-
tinue Arnica.

Nov. 27th. Vision perfect. Outlines of disc now for the first time
clearly defined, though there still remains a little retinal hyperemia.
Iris dilated ad max. in vicinity of coloboma, not so much so on inner
side. No reaction to light. Slight crescent at the inner edge of disc,
and choroid pale around it for a distance of one disc diameter. $
Eserine, 1 per cent, solution three times a day.

Dec. 28th. Has been using Eserine since last date. It contracts
the pupil temporarily but the effect passes off in about two hours,
when the pupil becomes as large and immovable as before. Discon-
tinue Eserine, and take Duboisin 3 X once in three hours.

Bbkeau of Ophthalmology.

22d, 1887. At this date the condition remains as previously,
lat two email synechias have formed at the edges of the c*h>
Sight is perfect.

sase interested me because of its uniqueness. I do not
;r to have read of a similar case of traumatic rupture of the
out an external wound. I at first considered the above
id crescent at the edge of the optic disc as a ^poBtstaphy-
t subsequent examinations proved the eve to be entirely
pic, and I concluded that it was a choroidal coloboma pro-
r the injury. Did I treat the case judiciously ? Would the
.11 the iris have been more likely to heal if I had used
it first, instead of Atropine ? Adhesions would most likely
med, but these might have been broken up by a subsequent
.tropine.

III. Hdonias Dioica in. inflammation of the optic nerve.
nothing in the pathogenesis of Helonias to suggest its applica-
any ocular affection, nor is there any reference to it in Nor-
iphthalmic Therapeutics." In the following case the im-
nt following its administration was prompt, decided and
nt. It ib, therefore, in the hope of adding another drug to
of those useful in the affections of the optic nerve and retina,
tcially when associated with renal disease, that this case is

! , 62 years old, consulted me first Aug. 9th, 1886. He

he formerly had had keen sight, but that it had been gradu-
ng for the past six months. It was then only ^ with either
ie field of vision was not accurately tested but it was markedly
id, for with strongly magnifying glasses he could only see
i of a printed word at once. The peripheral field was, how-
fc entirely wanting, as he noticed the movement of my hand
rections. With the ophthalmoscope the optic disc in each
lost its transparency and presented a blurred, hazy appear-
th indistinct outlines. The retinal veins were somewhat
and the arteries upon the disc were small and somewhat
y an apparently serous infiltration. The fundus in other
presented a natural appearance. The gentleman was ana>mic
le, and his eyelids were cedematous. An examination of the
re the following results : Quantity in 24 hours 5 gills, turbid
acid and sp. gr. 1018, and containing a trace of albumen.
ie microscope numerous pus corpuscles, a few epithelia from
les of the kidney, and some fatty and granular casts were

Bureau of Ophthalmology. 135

seeu. Under treatment his general health improved, and with it the
vision, until the record, Oct. 16th, was : v. o. u. as before — ^{j-, but
+ 16 makes it $$. The urine increased in amount and became less
turbid and the albumen disappeared, but there was no material change
in the microscopical ppearance. The next record was Oct. 23d.
Vision j^$ but only w with glasses. This was the only time that
vision without glasses was more than ^fc, and there was no further
improvement with glasses. Nov. 22d the condition was as follows :
Vision as it has been for the past 5 weeks, viz., ^^ without glasses,
and with + 16. The retinal veins somewhat swollen and a faint
cloudiness of the disc and of the retina immediately snrrounding it.
Outlines of disc better defined and less veiling of the arteries. He
had gained nearly 20 pounds in weight since he first consulted ine ;
had a better color, but was still weak, though able to walk a mile and
a half to my office, as he had done all the while. He complained of
a constant dull pain in the lumbar region, extending around the hips
and down the legs, and also of a sensation as if the forehead was
encircled by a tight band. These symptoms suggested Helonias, which
I prescribed in the l x , 2 drops four times daily. It was followed by
surprising improvement in vision. In one week the vision rose to $$
without glasses, and £# with + 16. In one month it was £# without,
and {% with glasses, and he was able to read 0.6 of Snellen's test types
with some hestitancy. Previously he had not been able to read even
large type. Helonias was continued uninterruptedly until Feb. 9th,
1887, with the exception of ten days in January, when Rhus was given
for constitutional symptoms. At this date, Feb. 9th, vision was $$
without glasses and {% with +16, and it has continued perfect until
the present time. He is able to read the finest print without discom-
fort 7 or 8 hours a day, although his general health gradually fails and
the urine contains pus cells in increasing quantities. During much
of the time while taking Helonias he also took Bovonine after meals,
but no other medicine, so that I think the improvement in vision may
fairly be ascribed to the Helonias. The last time that I examined his
eyes the fundus appeared absolutely normal in every respect, aside
from a slight pallor of the disc. One peculiar feature of the case
was that he always maintained that he could see very much better in
the twilight. I found this symptom under China, Ferrum, Hellebore
and Phosphorus, but notie of these remedies, given in the early history
of the case, relieved the symptom.

136 Bureau of Ophthalmology.

DIPLOPIA-A CLINICAL CASE.

By John L. Moffat, M. D.,

BROOKLYN.

In April, 1885, Mr. E. A. D., aged 48, a spare, stooping business
man of nervous temperament, complained of confusion and uncertainty
in distant vision, with vertical diplopia and slight photophobia. On
inspection there was no marked malposition of either eye, but tests
revealed myopia, presbyopia and muscular asthenopia.

R.E. V.&M.1.25 D (V. i+).

L. E. V. A, M. 1 D (V. f+).

N. V. Sn. 0.5, p. r. 50 cm pp. 27 -»

with + 0.5 D Sn. 0.5, p. r. 50 cm difficulty.

M. Eect. Int. dextra 12 p difficulty,
u (c « gi n# 12° at first, then 10 p , this at a distance without

glasses.

A red glass before the left eye showed the diplopia to be homony-
mous ; upon looking directly to the left the red image appeared to the
left and higher — upon looking downward and to the left the displace-
ment was exaggerated, but both images were still vertical.

A week later the diplopia was crossed, instead of homonymous, and
varied during examination, but the patient reported the eyes as being
stronger. Now the red image (in the right eye) appeared behind the
other upon looking forward, and also directly to the left, while down-
ward and to the left it was crossed and tipped inward, showing that
weakness of the right internal rectus predominated at this time over
that of the left externus, existing at the first test.

]jfc. + 0.5 D for near vision, Dyer's exercise and Comum* on pellets,

every 3 hours.

Six days later he reported improvement, but examination showed
momentary homonymous diplopia upon looking directly to the left

Con.* 00 3 hours.

Three weeks later he reports the eyes " well some time ago," but
now is troubled with a dull — sometimes sharp — supra- orbital neuralgia
of the right side, occasionally extending down into the cheek; better
when interested in other matters. Worse in stormy weather. Cedron
l x 3 hours failed but Kalinia,' 9, on pellets apparently afforded relief.

' \

Bubeau of Ophthalmology. 137

Two years later, in June last, the patient returns with diplopia, which
has been growing worse for two days, relieved by looking to the left ;
vision blurs on looking to the right ; he cannot abduct the right eye ;
homonymous diplopia, paralysis of the right externus. He has been
reading much ; the eyes feel hot and weak and are sensitive to bright
light. Gave Con." 6, 2 h., and every two days primary faradism for about
three minutes from the eye to the occiput. Under this treatment he
improved slowly — more slowly than in the former attack. The right
supra-orbital neuralgia recurred, and Gels.* was substituted for the Con.
and the electricity changed to the interrupted galvanic current, l m *
for five minutes, positive pole on the insertion of the rectus externus.

Incidentally, two doses of Gambogia 3d stopped a watery diarrhoea,
coming with a burst that he had had for two mornings, while upon drop
doses of Gels.* 2 hours apart. It did not recur, although the Gels, was
continued three drops three times a day.

A week later, just a month from the beginning of this attack, he
complained that with the left eye objects looked smaller, and of vertigo
upon quickly covering this eye, which, upon being tested alone, everts
only about three-fourths as far as it should, and upon the binocular test
it abducts tremblingly three-fifths. There is concomitant (?) conver-
gent squint, and spasm of the ciliary muscle.

N. V. E. E., Sn. 0.5, pr. 45°"* p. p. 39 cm

1. e. blurs and changes.
+ 2 D brings the near point for Sn. 0.8 to 23 cm for the right and
22 cm for the left eye.

5&. d. V. — 1 D N. V. + 1.5 decentered inward.
Jabor. 1 4 td.

The minus glasses strained the eyes, and were discontinued and
Caust. given three times a day, since which time, seven weeks ago, he
has considered himself cured.

The above case is deemed of interest enough to report, because the
asthenopia varied so in the muscles involved, and also as an interesting
case of pseudo-myopia. It is regretted that the total degree of hypero-
pia was not ascertained by Atropine or the ophthalmoscope ; probably
it is quite high as the age, 48, is rather early for such an amount of
presbyopia. The whole trouble is doubtless attributable to not wearing
proper glasses several years ago ; as soon as the presbyopia is properly
corrected all of the symptoms disappear. The trouble recurred because
the firtot glasses given did not take off the strain upon the accommo-
dation.

JWL^VVj»T , f»TV;'vi:^, t r^» , >*' '

t^&itS-i*'-'- *<H*.

•> ■ i
.**•>•:

'^'••;>

<••;/»•'.•

138 Bureau of Ophthalmology.

The minus glasses were ordered for distant vision, because the sight
was so poor, especially in the left eye, that the desire for binocular
vision was lessened. The fact that they had to be discarded confirms
the diagnosis of pseudo myopia.

Discussion.

Dr. Nobton : There is very little opportunity for discussion in
clinical cases. The first case of Dr. Linnell's in which Colocynth
seemed to cause a serous inflammation of the uveal tract is of decided
interest. Colocynth has been used with benefit in the severe neuralgia
which accompanies glaucoma, a somewhat similar disease to serous
irido-choroiditis. It has not, however, so far as I know, ever before
produced an inflammation of the eye.. In Dr. Linnell's case the drug
seemed to act upon the secretory tract producing iifbreased secretion
without resulting in severe pathological changes, as is evidenced by
perfect restoration of vision. It may, therefore, prove a valuable
remedy in this class of cases. Heretofore Gelsemium has been the most
commonly indicated and most generally useful remedy for serous
inflammation of the uveal tract, while in the plastic variety of inflam-
mation. Kali iod. 1 has been of more service than any other one
remedy.

Dr. VanDenbubg : In regard to the use of Colocynth in inflamma-
tory states, a case that lately came under observation may be in point.
It embraced the infra-orbital nerve and its distribution; a nerve
somewhat intimately connected externally with the ophthalmic
branches. The muscles of the right side of the face were nearly para-
lyzed ; the pain was intense in one or two, or occasionally three, sharp,
terrific stabs. The least touch to wipe the eye or the nose, chewing,
winking, if not with the utmost care, served to kindle excruciating
paroxysms. For two years this had been progressing without relief,
except the temporary respite afforded by Morphine. Cold also
aggravated; motion of body, other things being equal, did not change
the attacks. The bridge of the nose was swollen, and two years ago a
nasal polyp was removed from the " left " side.

Colocynth 3 X rekindled the pain with extreme fury. Colocynth

■

3 m , 5 drops night and morning, afforded great relief. The case has

BUBRATT OF OvRTBAlMOJJOGY. 139

been under observation for only about two months. The main point
to be noted is extreme aggravation from touch, or motion ; relaxed
muscles.

Db. Norton : All ophthalmologists agree with Dr. Deady as to the
importance of careful adjustment of glasses. This is true in regard to
all errors of refraction, but especially so in myopia and astigmatism, in
which conditions competent advice should always be taken. The
selection of glasses by the patient or by an optician who does not
understand the construction of the eye and its refractive media,
and only desires to sell the glasses, is particularly reprehensible. It
leads so often to permanent injury of vision.

Dr. Deady : I am aware that good authorities advocate the full
correction of the myopia, and I do not wish to be understood as differ-
ing from them. Every oculist knows that in examining myopic
patients the vision is improved progressively as we apply stronger
lenses until a certain point is reached ; beyond this point no actual
increase of visual power can be obtained, but we find by experience
that the patient will generally prefer a glass a number or two stronger ;
not because he can read any more letters with it, but because it gives
him a brighter picture. I think that, as a rule, we should give the
weakest lens which will enable the patient to most nearly approximate
perfect vision.

Db. Sayer : When one feels the need of an aid to vision it is most
important for his future welfare that he finds out whether he
has any refractive error or not, and hence before putting on glasses
he should always consult an oculist.

As an illustration of the wide extent of refractive errors, in a large
English school of about 1,000 pupils, 703 were found to have some
form of refractive trouble.

Foerster and some other of the Germans, I believe, are now advis-
ing the full correction of myopia by concave lenses as a prevent-
ive against the increase of myopia, but here, as well as in hyperopia, I
believe that each case is a case in itself.

Db. Norton : Gelsemium is, I believe, the most valuable remedy we
possess in serous inflammation of the choroid. This fact I first brought
out in a paper published in the Hahnemannian Monthly some twelve
years or more ago, and my experience since then has only served to con-
firm my first impressions. I now always rely upon it in serous choroiditis,
unless the local or constitutional symptoms point strongly to some other
drug. In detachment of the retina, most excellent results have followed

i' '. .. -

t I

140 Bubeau of Ophthalmology.

its rise. At the Ninth International Congress, justheldin Washington,
Professor Galezowski reported that in 152,000 cases of eye disease he
had found detachment of the retina in 785. Among this number he
had seen a cure effected in only 7. With homoeopathic remedies we
can do much better than this.

Dr. Hasbrouck : I have never had any satisfactory results from the
use of Gelsemium in cases of detached retina, and believe that rest in
bed, in recent cases, will do all that anything can, and that chronic
cases are about hopeless.

Dr. E. H. Linnell : Casts disappeared although the disease seemed
to go on. Judged the curative effect to be from direct action upon
the eye, and not through the general disease ; said kidney disease was
gradually increasing.

Had treated several cases of detachment of retina with Gels, with no
effect.

Dr. Jonn L. Moffat : I have more than once relieved inflamma-
tion of the lids, conjunctiva, and even of the iris, by neuralgic remedies,
as Cedron and Spigelia.

I always urge my patients in buying eye-glasses to get the long kid-
ney-shaped case, so as to avoid doubling the spring, which otherwise
would soon become distorted.

REPORT

OF THE

BUREAU OF OTOLOGY. x

J. Edwin Pratt, M. D., Chairman, - - New York City.

Drs. Henry C. Houghton, - - - New York City.

Wm. P. Fowleb, .... . Eochester.

N. B. Covebt, Geneva.

W. E. Rounds, --.--- New York Citv.

F. Park Lewis, Buffalo.

A PRACTICAL MODIFICATION OF VALSALVA'S

EXPERIMENT.

By Henry C. Houghton, M. D.

Inflation of the middle ear is an established procedure in the prac-
tice of aural surgery ; the methods by which it is performed have their
advocates who are enthusiastic, or otherwise, as the case may be, their
views being based on their own personal experience.

Inflation by means of the catheter was first effected by a layman,
who relieved himself of deafness by a tube passed to the mouth of the
eustachian tube, through the mouth, rather "than the nose. Wilde
claims that Cleland was the first to practice catherization in the usual
way. Valsalva's experiment is the result of careful anatomical study,
but was superseded by the catheter. Politzer's method is also the
result of anatomical study and physiological observation ; it is the
simplest and best method of inflating the tympanum.

It must be admitted all methods of inflation are open to objection ;
every agent for good may be perverted. The eustachian catheter is
an uncomfortable necessity, even in the hand of an expert; an instru-

142 Bubeau of Otology.

ment of torture in the hand of a bungler ; a cause of death in certain
cases of medica-legal history. Politzer's method was used without
caution for a time, until patients (in whose hands it had been placed for
weekly or even daily use) reported bad effects following its operation,
then warnings were heard from aurists and its use has been restricted.
- The late C. Th. Liebold, M. D., recognized this fact and cautioned the
profession as to its ill effects.
:* ;*• Study of the cases that are uniformly worse after iuflation has led

>.; ' me to the opinion that the impairment of f miction is due to displace-
ment of the malleo-incal articulation for we find that upon re-ad just-
<~^ ment of the relations of the mechanism of the ossicles the function has
:v*v not improved, but usually show the same distance for watch

&•; -i as before inflation. Hence, the object of inflation should be the
i patency of the tube, then the tension of the air in the tympanum will

|,-x adjust itself ; but if inflation cause undue increase of the air pressure

(:> > the membrana tympani is forced outward abnormally, and repeated
'}.-) inflation simply adds to the previously existing defects. Noticing that

0/ r writers advised inhalation or swallowing with closed nostrils, in order

'/'• to readjust the displaced ossicles; also watching the effect of Lncae's

'Q. .?'" " stemple " for producing direct pressure on the malleus in order to

1{; overcome rigidity of the articulations, I have been led to modify

Valsalva's experiment in the following report :

As you are well aware this experiment is performed by closing
the anterior nares and the mouth, then the attempt is made to expel
the air from the lungs through the nose ; necessarily the volume of
air finds one avenue of exit through the tube to the middle ear.
Many patients discover this mode of relief inadvertently and prac-
tice it to their detriment. Many physicians advise the practice till
some story of bad results comes to their notice. During the last year
I have directed my patients to close the meatus auditorius externus
with the middle finger of each hand, to carry the thumbs downward
and inward, closing the anterior nares gently but firmly, then exhale as
usual. In using Politzer's air bag or the eustachian catheter the same
caution should be observed, close the external meatus. What may be
termed aural massage may be practiced by alternate inhalation and
exhalation keeping the anterior nares and external meatus securely
closed.

One case that has been under observation more than two years is a
very marked illustration of the utility of this method. A strong, intelli-
gent school girl of about fourteen had catarrhal inflammation of both
tympana, suppuration had occurred several times as sequels of super-

Bureau of Otology. 143

ficial and parenchymatous tonsillitis. Inflation had been practiced by
catheter and Politzer's method by competent practitioners till she had
a dread of all efforts to inflate the middle ear. I used Politizer's
method gently as possible, and satisfied myself that there was an
unusual sensitiveness ; the patient would involuntarily cover both ears
with her hands. During the past year I taught her this modification
of Politzer's method and have the pleasure of reporting uniform
improvement, as well as being greeted with a smile on the occasion of
her visits.

I have not offered this suggestion in order to set aside the methods
in use, but all who are compelled to guard against the injurious
results of rather heroic practice are glad of any suggestion which
may tend to increase the effectiveness of accepted methods. As
such only do I offer it to my colleagues.

AN IMPROVED MEMBRANA TYMPANI

By Sayer Hasbrouck, M. D.,

PROVIDENCE, R. I.

Reference to the valuable work of Dr. D. B. St. John Roosa, of
New York, shows that Dr. James Yearsley, of London, first introduced
the artificial membrana tympani, having profited by information
gained from a New York layman, who was able to improve his hearing
by the use of a " spill of paper previously moistened, with cotton at
the bottom of the passage," though Yearsley substituted cotton wool
for the paper, which substitution until this day has continued in
general use.

Previous to Yearsley, Marcus Banzer, in 1640, and many others
after him, recommended an hollow tube covered with pig's bladder or
some similar substance, as a protection to the middle ear where the mem-
brane had been destroyed, these might very properly have been called
artificial membrana tympani, but they were not intended as an aid
to hearing. •

In 1853, Toynbee suggested another artificial membrana tympani,
which, until this time, has been the one most frequently used. The
Toynbee drum consists of a thin disk of rubber, to the center of which
is attached a fine gold wire about an inch in length, so that it can easily
be adjusted by the patient.

*>;'

144 Bureau of Otology.

I know that aurists are Dot inclined to value the use of the artificial
dram very highly, as they find that even though it may improve the
hearing at first, the improvement does not last for a satisfactory length
of time and the patients very shortly find it of more annoyance than
utility.

From a knowledge of the fact that artificial drums tended to improve
the hearing in many cases for only a brief time, I was led to believe
that the drum must become easily displaced after being put into
position.

In seeking a satisfactory reason for this displacement, no fault could
be found with the rubber disk or the wire attachment, as it seemed to
answer every purpose for which it is intended, but from its location in
the middle of the disk it tends to drag the upper edge of the disk from
the remains of the membrane and ossicula.

To fulfil its intended purpose an artificial membrana tympani must
first be placed in contact with the remains of the membrane and
ossicula and kept in position.

In those cases where the Toynbee drum has been of continued bene-
fit the floor of the meatus has probably curved upward, or there has
been a slight adhesive secretion, gluing the disk to the membrane
and furnishing the necessary support to the wire.

I have tried to support the disk by making a double elbow in the
wire, but this would turn and fail in its support.

I finally had an artificial membrana tympani made after the follow-
ing design : The disk is of thin rubber as in the Toynbee.

The gold wire for adjustment spreads out into a V ; the V being at

right angles to the stem, (like this V o), and should not extend

above the center of the disk, to which is attached the wire for adjust-
ment coming out at the lower edge.

The V gives the necessary support to the disk,
O th e w * re from the lower edge being about an
inch in length allows of its easy adjustment.

I will say right here that the artificial membrana tympani should be
adjusted for the first time by the physician, with a hand mirror and
reflected light, so that he can see when the disk has been trimmed
down to fit smoothly, and if "necessary bend the wires to give the
proper support.

I have had the Vs made of different sizes in accordance with the size of
the meatus. Many patients complain that the riveted end of the Toynbee
wire causes a disagreeable irritation ; to overcome this I have attached
the disk to the wire by cementing the V between two rubber disks.

Bureau of Otology. 145

As yet it has been used in but few eases, though all of these have
proven very satisfactory. It is unnecessary to add that the artificial
membrana tympani is not applicable in all cases of deafness, but for
those in which a portion of the membrane is yet undestroyed, and the
mobility of the ossicula patent, its use will generally give a fair degree
of satisfaction. At first the drum should only be worn for a short
time, but by degrees many will be able to use it more or less con-
stantly.

You will find that it acts as a protection to the mucous membrane as
well as improving the hearing. ^

When it is realized how many cases of defective hearing begin in
early life, and thus lay the foundation of a possible series of disadvan-
tages and discomforts, it should be the aim of our profession to
endeavor to overcome such defects by every means within our grasp,
and it was this that prompted me to direct your attention to this new form
of artificial membrana tympani which I have devised.

The device is now presented to the profession with the hope that a
more general use of it will confirm my experiences, and be the means
of alleviating the condition of a large number of the unfortunate deaf.

AURAL MUCOUS POLYPI.

By Chas. C. Boyle, M. D.,

NEW YORK.

I wish to call attention to these growths on account of the intimate
relation they bear to the chronic discharges which accompany a great
many cases of suppurative inflammation of the middle ear, they being
the product of it, and it is impossible to cure the original trouble until
they are eradicated. They are found attached to some portion of the
mucous membrane of the middle ear, generally at the posterior edge
of the remains of the membrana tympani, which has been destroyed
by the destructive changes. They are analogous in structure to
exuberant granulations, occuring as a direct result of an ulceration,
consisting of a delicate but loose stroma connective tissue and numer-
ous # granulated cells. The surface of a mucous polypus is generally
smooth and rounded, as it grows it becomes constricted at its attach-
ment, forming a pedicle. They vary greatly in size, shape, color and
consistence, their average size is that of a small bean.

146 Btoeau of Otology.

In cases of chronic suppuration of the middle ear, accompanied by
a discharge which has long resisted treatment, one of the probable
causes is the presence of a polypus, and it is impossible to cure one of
these cases as long as this growth remains. It does not, as a rule,
cause much pain, but by the obstruction it causes in the canal it pro-
duces such unpleasant symptoms as stuffed sensation, deafness, tinnitus
aurium and aural vertigo, besides being a constant source of irri-
tation, thereby keeping up the discharge, and where large enough, will
so obstruct the canal as to cause a retention of the purulent matter,
inducing increased inflammation and danger of its extension to the
meninges of the brain.

The treatment for polypi begins with their removal, which is usually
done with the wire snare, or if small enough by the curette, after
which it is necessary to treat its base or point of attachment with some
local applications or by the curette, until all vestige of it has disap-
peared, otherwise it will soon return. Combined with this treatment
we also use the indicated homoeopathic remedies.

Will give histories of two or three cases treated thus : One was
that of a boy, who had a chronic discharge from both ears, with great
hardness of hearing.

On examining ears, found auditory canals completely filled by two
large polypi, one in each, about the size of a large hazel nut, project-
ing from the canals in the form of a small round fleshy tumor. On
closer examination found that they were connected to the edge of the
posterior wall of the tympanic cavity by a pedicle. I removed them
both by the wire snare, and treated the stumps by scraping off as much
as I could with the curette and applied a dry powder of Monsel's salts
(Ferri persulphate). Besides this cleaned the tympanic cavity with
absorbent cotton and Hydrogen peroxide, and at the same time giving
such remedies as Kali sulph., Thuja, and Silic., as indicated. After
about a month's treatment the discharge stopped from one ear and all
remains of the polypus had disappeared. The other ear still continued
discharging, which was due to my not being enabled to remove the
entire remains of the polypus, this continued until I succeeded in
removing all traces of it, when the discharge ceased.

Another case was that of a lady, who had had a chronic suppura-
tion of the ear for a number of years, accompanied by aural vertigo.

On examining ear found entire absence of the membrana tympani ;
a polypus about the size of a large pea was attached to posterior wall
by a pedicle, accompanied by a profuse yellowish, offensive discharge.
I removed polypus by the snare and touched its pedicle with the

¥,-'. ,..*^^«^..

Bureau of Otology. • 147

Nitrftte of silver stick to prevent its returning. I then treated the
suppuration of the ear by cleansing it with cotton and Hydrogen per-
oxide, and blowing in Boracic acid powder, and gave remedies inter-
nally, as Hep. s., Kali sulph. and Silic. Under this treatment improve-
ment took place, but the aural vertigo did not cease until I gave her
internally Onosmodium, which is a special indication for the employ-
ment of this remedy in ear diseases, and while taking it she had quite
a proving of the drug, developing symptoms which she had never
complained of before and which ceased on stopping medicine.

Within this last month have removed a small polypus from an ear
which has been discharging for several years. I have been treating it for
some time by applications and remedies, but with no result, but as soon
as polypus was removed the discharge ceased with further treatment.

These cases show the necessity of removing any polypi that may
exist before attempting the cure of a chronic suppuration of the mid.
die ear.

Dr. Norton : This suggestion of Dr. Houghton's is a very wise
one. The doctor also refers to the dangers of Politzer's inflation. I
do not think that there is usually much danger from this method,
but yet, in some cases, I know there is. I supposed, for years, that
there was no danger, and used it indiscriminately, until a lady came
to my office, with slight catarrhal inflammation in the middle ear ;
only a very little inflammation of the drum, but moderate dullness of
hearing. I used the Politzer's inflation ; immediately afterward
she complained of a little pain. An examination showed that there
had been a rupture of a blood vessel in the membrana tympani,
which was densely filled with blood so that even the handle of the
malleus could not \>e seen.

The blood vessels in this case were evidently in a weakened state, and
the inflation of the middle ear had produced a rupture. The hem-
orrhage was readily absorbed and the patient perfectly recovered her
hearing, but it taught me that there is danger from an indiscriminate
use of the Politzer in acute cases. I have never seen any serious
results in chronic inflammation of the middle ear.

Dr. Hasbrouck : This new method of inflation that Dr. Hough-
ton has given us this evening is one that, in a modified way, I
have been in the habit of using for a long time. I first learned
it in Dublin, at St. Mark's Hospital. In a case where one ear was

Bureau of Otology.

1 seemed to need treatment, whenever we used the Polit-
1, we always advised the patient to pat his finger in the
nd in that way we thought we supported the membrane
>t in any danger of injuring it. I, myself, have at times
rrhal condition of my left ear, and whenever I inflate it I

my finger in my right ear ; and thus it has always
lod familiar to me, in a one-sided way, so to speak. But

its value in other cases, I am very glad to hear the sug-
; Dr. Honghton gives to oa of protecting both ears.

jhtom : I wish to add one word more in regard to the
o which Dr. Kortou has referred. Dr. Liebold showed
' that while great mischief may resnlt in acute diseases of

ear, and particularly when the membrane is, as the Eng-
s it, sodden, because the force applied would rupture and
■foration in the form of a pin point, or a slit, in the direc-
longitndinal fibers ; yet, it is by the lay use of the instru-
nost mischief has been done. You have, in that class of
;e unusually open, the so-called sclerosed condition of the
In the acute or hypertrophic state, the walls of the tube
sition all the while, notwithstanding what the external or
uble may be ; but when this state of things has passed by,
'-mucous tissue has been absorbed, if undue force is used,
t unnaturally opened, and the ossicles are displaced, the
being stretched until there is a demand for the various
jgested by the German aurists for contracting the drum
racticed by Dr. Liebold. Lacar devised an instrument for
; the rigidity of the ossicles ; it was brought to me by Dr.

Boston, theoretically it is admirable, bnt I do not think
of extensive practical use.

ohton : I believe the Society is not as much interested in
subjects as when it was organized ; but if we have a
iich will do certain work, we should be willing to try it.
y of Schussler's work I find that Kali muriaticum is the
;gested for just this form or process, and I have tried it
i at the N. Y. Ophthalmic Hospital. I am satisfied that the
b he made was correct.

Rir : I would like to ask the doctor, if inflation be used
itina, the same indication being present, what results there
f any I

Bueeau of Otology. 149

Dr. Hasbrouck : I would state that that is just the case in which
you would get the most advantage, provided you still have the
ossicles and a portion of the membrane left.

Of course, there are cases following scarlatina where there is very
serious damage, and in these the artificial membrane would be of
little use.

♦REPORT

OF THE

BUREAU OF PAEDOLOGY.

(1886.)

Helene S. Lassen, M. D., Chairman, - - Brooklyn.

Drs. Gertrude Goewey- Bishop, - - - Brooklyn.

Susan 8. McKinnej, Brooklyn.

"W. L. R. Perrine, Brooklyn.

With invited co-operation of

Drs. Georgia A. Cassidy, Brooklyn.

M. Elizabeth Clarke, Brooklyn.

Isabella M. Rankine, Brooklyn.

Juliet Van Evera, ..... New York.

Phcebb J. B. Watte, New York.

Susan G. Dugal, Philadelphia.

♦No report from the Bureau of 1887.

MARASMUS INFANTUM,

Br S. S. McKinney, M. D.,

BROOKLYN, N. Y.

Of the many diseases to which children are victims, marasmus is to
me one of the most interesting, from the fact that my success in enter-
ing upon and building up a comparatively fair practice is, in a measure,
due to the good results I have had in the treatment of this disease.

One of my very first cases after graduation was that of a little
patient afflicted with this disease, whose parents had become discour-
aged with the old school treatment, and, as they stated, were willing to
gis^e me a trial.

The case was a typical one. I put forth my best efforts, supple-
mented by careful nursing on the part of a loving and intelligent

BlJEEAU OF PAEDOLOGY. > 151

mother, and in time my little patient rounded out into a fine healthy
looking child, rewarding my labors in its behalf by being the means of
other children being brought to me, similarly afflicted.

Thus all along the line up to the present time I find myself being
called upon as one able to alleviate the sufferings, if not always able
to cure the condition.

Diagnosis : The word marasmus is derived from the Greek, mean-
ing "I grow lean," and is used synonymously with the word atrophy.
The name has been fitly chosen for the condition, and indicates a general
waste of all the tissues from malnutrition.

This disease may develop at any stage of infantile life, and is chiefly
the result of the following causes : Unsuitable food, chronic vomit-
ing, chronic diarrhoea, worim in the alimentary canal, and more espe-
cially inherited syphilis.

It is not always the result of functional derangements, but may be
associated with, and is often the sign of, some grave organic disease.
Although the exciting cause may sometimes be obscure, the condition
is not difficult of diagnosis and is recognized by the physician at a
glance.

The most prominent symptoms are : Emaciation exhaustion, hectic
fever, vomiting, diarrhoea or constipation, dark and shrivelled skin
or an oedematous condition of the same, anorexia or great voracity,
thirst, sweats, bloated and hard abdomen, enlargement of the glands,
great restlessness and nervous irritability, and a host of other symptoms.

Prognosis : The prognosis depends very largely upon the exciting
causes, the duration of its existence and the condition of the little
patients at the time they are presented for treatment.

If the condition is the result of bad feeding, either from unsuitable
food or proper food injudiciously administered, which has provoked a
chronic catarrhal condition of the digestive organs, thus interrupting
normal digestion and assimilation, if not of too long standing, these
cases generally yield to careful homoeopathic treatment without much
trouble. If, on the contrary, extreme emaciation and exhaustion exist,
complicated with some organic disease, or if of syphiltic origin, the
prognosis is most unfavorable.

Treatment : In taking charge of a case of this disease, I make it a
rule never to promise a cure, but say I will do all I can to restore the
little patient to health.

I shape my course of treatment to suit each individual case as pre-
sented, directing careful attention to the dietary and hygienic needs of
the little patients and apply homoeopathic remedies according to their

152 BUREAU OF PAEDOLOGY.

symptomatology. The following remedies have given the most satis-
factory results in the treatment of this disease, either in assisting to pro-
mote a cure or in alleviating the sufferings of such cases as have
resulted in death : Aconite, belladonna, calc. carb., arsenicum, silicea
bryonia, chamomilla, sulphur, ferrura, lycopodium, nux vomica,
china, cina, mercurius and graphites.

In connection with the homoeopathic remedies, I put the little
patients on cod- liver oil (Iodo fervatea), using it topically as well as
constitutionally, where there is great emaciation and dryness of the
skin, and particularly in cases of syphilitic origin.

Where children are artificially fed I have found Maltine, as prepared
by Reed and Carnrick, a most excellent food diluted with good milk.

I am now using, with good results, Carnrick's "Soluble Food," as
it more closely resembles human milk in the proportion of its constitu-
ents and digestibility than any other food at present obtainable.

My rule is to have the child fed with a spoon (silver), and thus dis-
pense with the nursing bottle, against which there are serious objections.

If the child is still nursing, I direct attention to the mother's milk,
and recommend such a diet as is necessary for a nursing woman.

If thfe child is old enough to be weaned and I find the mother's milk
at fault I order the child weaned and placed upon the proper food.

Sun-light and fresh air are necessary auxiliaries in the treatment of
this disease.

While I feel that I have been successful in the treatment of maras-
mus, I do not claim to have been more successful than the average
homoeopathic physician (could we compare results), but I do claim that
this disease, as well as all other children's diseases, stand a far better
chance of recovery under homoepathic treatment, and this class of
patients do much in the way of converting the public to our methods of
practice.

As in my case, perhaps there are others who can remember some
infantile disease they have treated successfully that has proved a step-
ping-stone to a busy professional career.

REPORT

OF THE

BUREAU OF MENTAL AND NERVOUS DISEASES.

Selden H. Talcott, M. D., Chairman, - - Middletown.

Drs. A. P. Williamson, .... Middletown.

D. A. Gorton, .---.- Brooklyn.

George E. Gorham, .... Albany.

Trrus L. Brown, Binghamton.

Wm. M. Butler, Brooklyn.

C. Spencer Kinney, Middletown.

With the invited co-operation of

Drs. N. Emmons Paine, ------ Westboro, Mass.

Clarence Bartlett, - Philadelphia, Pa.

NEURASTHENIA.

By Wm. M. Butler, M. D.,

BROOKLYN, N. Y.

Neurasthenia, or nervous exhaustion, is a disease characterized by a
general derangement and disturbance of the functions of the nervous
system.

This disease was first classified and minutely described by the late
Dr. Geo. M. Beard, in a paper read in 1868, before the New York
Medical Journal Association, and published in the first edition of
Beard and Rockwell's Electricity. Previous to this publication,
although frequently encountered, it was regarded by the profession as
one of the phases of hysteria, or scoffed at as merely the product of
the patient's over-wrought imagination. Since this first publication,

154r Bureau of Mental and Nervous Diseases.

Beard's elaborate monograph upon this subject and descriptions of the
disease by Dr. Hugh Campbell, of England, Prof. Erb, of Heidelberg,
Grasset, of Paris and Rosenthal, of Vienna, and articles by less noted
writers, have verified its existence and given it an established place
among the disorders of the nervous system.

Etiology. — Arising from a deficiency of that mysterious power we
call nerve force, it may be caused by any one of a multitude of agencies
which exhaust the nervous system.

Although liable to occur in either sex and at any period of life,
certain persons seem naturally susceptible to its invasion. These indi-
viduals always attract by their brightness, sprightliness and keen wit.
Favorites in the circle in which they move, their nervous system seems
continually keyed above concert pitch. Extremely sensitive and utterly
regardless of their natural resources in work or recreation, they invar-
iably go beyond their strength. Precocious children, the pride of
ambitious teachers and foolish parents, are found in this class, and too
frequently is their life's work mined by their school and college honors,
achieved in hours stolen from rest and sleep. Many a beautiful girl,
with the plaudits of her teachers and friends over her valedictory essay
ringing in her ears, steps from her graduating stage down into a life of
pain and chronic invalidism produced by this disease.

While these high strung, sensitive organizations are especially liable,
none are exempt from this disease. Constant work and worry, whether
over the intricate schemes and combinations of the counting-room and
stock exchange or the endless cares of the household, may in time
prostrate the man or woman of iron nerve.

Sexual excess, in either sex, is one of the commonest causes. Con-
stant seminal drain, whether from masturbation or too frequent inter-
course, renders the male especially liable to the disease.

Any acute disease which exhausts the general system and does not
yield to treatment, may plunge the patient into the depths of neuras-
thenia and leave him for months or years a sufferer from this dread
disorder.

In addition to the causes mentioned, woman may fall an easy prey
to this disease from too frequent labors and miscarriages, profuse flood-
ings, prolonged leucorrhoeas and chronic uterine troubles. Exhausted
by any of these predisposing causes, the slightest shock or over-exer-
tion may act as an exciting cause and produce in their full develop-
ment any or all of the symptoms of neurasthenia.

Symptomatology. — To describe the totality of the symptoms liable
to be encountered in this disease would be to reverse every normal

Bureau of Mental and Nervous Diseases. 155

sensation which the nervous system is capable of producing. As well
might you attempt to describe the changes of a kaleidoscope or paint
the fleeting tints of the chameleon. • ,

From the top of the head to the tips of the toes, wherever a nerve
is distributed, abnormal sensations may arise, singly or in the most puz-
zling combinations.

For convenience of discription we shall mention, in their natural
order, a few of the common symptoms liable to be encountered.

Mind. — A peculiar mental feature, often observed, is the presence
of a variety of morbid fears, differing from insane delusions from the
fact that the patient admits their foolishness but cannot throw them
off — as an example I would cite a recent case of a friend of mine,
a lady, who was afraid to go into her parlor. An example of what
Dr. Beard calls " mysophobia, or fear of contamination," I encount-
ered in a patient of my own some months ago. This lady, when walk-
ing near any other person, unless she brought her reason to bear upon
it, would involuntarily brush off her clothing. In both cases these
symptoms disappeared with improved health. Others are greatly
depressed and fear constantly some incurable disease or impending
insanity, but the depression usually stops short of positive insanity.

Head. — Dizziness of every form is of common occurrence. A vol-
ume could scarcely describe all the head symptoms of which the suf-
ferers complain. General and circumscribed heat or cold, bands about
the head, opening and shutting of the skull, squeezing of the brain,
drawings and pullings up and down, in fact every conceivable sensa-
tion which an active imagination can invent, is liable to be encountered.

In nearly every case sleep is more or less disturbed. While some are#
almost absolutely sleepless, others only sleep in the first or last hours
of the night. In all, even if they get an apparently sufficient quantity,
the sleep fails to afford the needed rest and recuperation. When a
drowsy state obtains, as sometimes occurs, we find the patient in the
morning fatigued and unrefreshed. One of the most encouraging and
reliable signs of permanent improvement is when the sleep becomes
continuous and refreshing, even if the normal amount is not obtained.

Chest. — Of the chest symptoms, the most troublesome are a sensa-
tion of suffocation upon lying down and numerous functional derange-
ments of the heart — palpitations, jumping of the heart, a feeling as if
the heart stopped, and cardiac pains, often closely simulating those of
angina pectoris.

Digestive Organs. — The symptoms of the digestive tract are numer-
ous, and often among the most difficult to overcome. Possessed of a

15rt Bureau of Mental and Nervous Diseases.

ravenous appetite or utterly devoid of all desire, and loathing the sight
of any food, it is at times almost impossible to get the patient to take
and retain *he nourishment which is absolutely necessary for the pres-
ervation of life, to say nothing of the recuperation of their greatly weak-
ened powers.

In addition to their nausea, vomiting, flatulency, obstinate constipa-
tion or diarrhoea, any or all of which, at times, we meet in the same
patient, complaints are made of burnings or coldness in the stomach,
trembling, faintness, drawings or a general relaxation. Some have crav-
ings for the most indigestible substances, otherp obstinately insist upon
their inability to take fluids, others strenuously oppose solids. How-
ever tractible upon other points, in regard to the matter of diet the
physician can rest assured that sooner or later he will meet with trouble
and opposition.

In adcHtion to the multitude of symptoms already enumerated, we
may have tenderness of the whole or portions of the spine, burning in
the spine, nervous chills, dull pain and aching in the different parts of
the back, ataxic pains in the limbs, numbness and pricking in the
extremities, coldness or burnjng of the feet and a feeling of general
exhaustion upon the least exertion. Many are troubled with the most
profuse sweatings of the hands and feet, or of the whole body. In men
frequent emissions and deficient virility, and in women leucorrhoea and
almost every form of uterine disorder are liable to occur. Profuse
menstruation is another frequent accompaniment. One lady, at
present under my treatment, has often fainted from her excessive
flooding.

Neuralgias of every variety torment the sufferers. A recent case of
mine for days was subject to the most excruciating agony from attacks
of intercostal neuralgia, producing the sensation of an ever tightening
hoop around the chest.

Many peculiar symptoms are also met with. I have now under my
care a young lady who has been greatly troubled with swelling and
inflammation about the nails of the great toes. Before coming into my
hands she had undergone a very severe course of treatment at the
hands of a chiropodist, for what he supposed to be ingrown toe-nails.
Upon close examination 1 was convinced that the nails were not
ingrowing, and the inflammation of the toes was but another one of the
numerous symptoms of her disease, and aside from keeping them
scrupulously clean, have paid no attention to them. The sequel has
proven the correctness of any opinion, and the toes have ever served as
a reliable index of her general condition — the inflammation increasing

BtTtKAU OF MkXTAL AND XfiRVOVS I>I$K&$1& 157

or subsiding with the fluctuations of the disease, and now, with approach-
ing restoration to health, all signs of inflammation are disappearing*

Such, in brief, is an outline of the most prominent symptoms of neu-
rasthenia.

Diagnosis. — The diseases with which neurasthenia is most liable to
be confounded are organic diseases of the cord, hysteria and amentia.

Upon a casual and imperfect examination, it may be difficult to dif-
ferentiate neurasthenia from some of the organic diseases of the spinal
cord.

The shooting pains in the limbs and the paralytic symptoms may
suggest looomoter ataxy. The ability to stand with the eyes shut, the
presence of the normal knee jirk and the absence of the Argyle Hob*
ertson pupil, or reflex iridoplegia, as it is sometimes called, and the
absence of the girdle sensation about the waist, soon dispels all doubts
upon this point.

In general, the changeable character of the symptoms distinguish it
from those of organic nervous disease, which are usually fixed and
stable

Its increased activity of the reflexes in contradistinction from the
diminished reflexes of organic disease of the cord is another pathogno-
monic sign.

Hysteria. — The absence of convulsions and the globus hystericus
and the less common occurrence of ovarian tenderness and anesthesia,
its more frequent occurrence in males, the great physical debility and
course of the disease will usually distinguish it from hysteria. In some
instances, however, hysterical symptoms are combined with those
pathogomonic of the disease, and in these cases the diagnosis is more
difficult.

Anosmia. — The nervous diathesis, the usual occurence between the
ages of fifteen and sixteen, the character of the pulse, often full or nor-
mal instead of weak and compressible, the absence of cardiac and ven-
ous murmurs, the usual absence of facial pallor, its almost universal
disturbance of sleep, more frequent occurrence in men, and more
chronic character, render it unliable to be confounded with anaemia.

Prognosis. — The prognosis of the disease, under proper treatment,
is usually favorable. The course, however, is ordinarily long and
tedious, months and years often being passed before complete recov-
ery is obtained. One great cause of the usual prolonged course of the
disease arises from the conduct of the patients themselves, who, dis-
couraged by their slow progress, are continually transferred from one
physician to another, giving to no one a fair chance, the last one get-
ting all the credit of the cure.

158 Bureau of Mental and Nervous Diseases.

Treatment. — The all important question in reference to neurasthenia
is that of treatment. How are we to cure our cases ? In considering
this question we must recognize the fact that no mere routine treat-
ment can be successful. No iron-sided rules can be laid down appli-
cable to all cases.

Each case must be studied by itself in its entirety. The individual
characteristics, the mental and physical symptoms, the surrounding
moral atmosphere of the patient, the influence of any agencies which
may have acted as predisposing or exciting causes of the malady, every-
thing which can in any way affect the future course of the disease,
must be considered before we decide upon a settled mode of treat-
ment.

If we find the patient exhausted by slight exertion and worried by
over sympathetic friends, we must insist upon isolation and absolute
rest in bed, the physician and nurse alone being allowed access to the
sick room. Yet this much lauded rest cure will not succeed with
every case, and if not indicated will prove an obstacle to recovery.

Many cases will improve more rapidly in their own homes, surrounded
by friends, and while engaged in the routine of their daily duties.

Some cases can be indulged in a generous general diet, while others
must be limited to the articles most easily digested.

All these questions must be decided by each individual practitioner,
and the decision must be made anew with each fresh case, as no previ-
ous experience is certain to be of value in the case in hand.

In every case the physician must acquire the patient's confidence
and gain supremacy over her mind or his treatment will be of little
avail.

Massage and electricity will be found the most reliable adjuvants in
a large majority of cases, especially when the rest cure is in progress ;
nor should they be discontinued until the patient is far upon the road
to recovery, or entirely restored.

When the physical strength is sufficiently recuperated, great aid will
be obtained by judicious outdoor exercise and enjoyable mental
diversion.

Yet, assisted by every external adjuvant, which he can bring to his
aid, the physician must apply his highest medical skill or he will fail
in working a perfect cure.

In the face of an endless multitude of ever changing symptoms, if
the homoeopathist seeks to find a simillimum which will cover them ,
all, he will soon find himself in a darker than Cretan labyrinth with no
Anadne thread to guide his wandering steps. In choosing his drug

Bureau of Mental and Nervous I)iseases. 159

the physician must eliminate many symptoms, the mere fruit of the
patient's overwrought imagination, and only consider those absolutely
essential in the causation and continuance of the disease. When this has
been done the most painstaking research of the materia medica will be
required for the discovery of the correct remedy, but when the drug is
discovered it tnust be allowed sufficient time to acomplish its work, and
not be superseded by another to meet each passing whim of the patient.
The list required by different patients is only limited by Allen's
index. No one can successfully combat neurasthenia who is content
with an annamentary more limited than the homoeopathic materia
medica itself.

Neusrasthenia and Melancholia.

By Selden H. Taloott, M. D

MIDDLETOWN, N. Y.

Neurasthenic conditions often terminate in melancholia ; and cases
of melancholia resulting from nerve exhaustion are frequently afflicted
with sudden maniacal outbursts. In evidence, we present the follow-
ing case :

No. 1908, at the Middletown Asylum, was a private patient ; female,
38 years of age, married, seven children, housekeeper, and above all, a
Baptist in religious proclivities. There was a predisposition to insan-
ity in this case, the insane relatives being a brother and a grandfather.
The patient has been passing into neurasthenic condition for over ten
years, and during that time became gradually much depressed in
spirits. Five weeks previous to admission, i. e., about June 1, 1886,
this patient's melancholia became intensified and she had periods of
great mental excitement and physical unrest.

Her certificates stated : " I first noticed mental delusions July 1,
1875. Have since had her under observation, and have noticed pecu-
liarities of temperament which always prompted me to suggest quiet-
ing surroundings. I visited her on the morning o^Jnly 9, 1886, and
found her actively maniacal, constantly in motion, and incoherent in
answer to questions. Fancies she has lost her chance for Heaven.
Constantly gives utterance to screams and appeals for help. Attempts
to jump from windows and shows a decided tendency to suicide."

160 Bureau of Mental and Nebvous Diseases.

Certificate No. 2 states : "An entire change in the patient's disposition,
as she is now sad and despondent, moans and groans, whereas she was
formerly bright and cheerful. Is sleepless, has delusions, thinks she
has nothing to stand on and nowhere to lay her head. Inability to
co-ordinate ideas; is impressed that everything is all wrong, that she is
in deep trouble. Has slight hallucinations ; recently has become inco-
herent and maniacal."

The daily history of the case while under care and observation is as
follows: When admitted, July 10, 1886, pulse 88, weight 93.
Numerous bruises over body, especially on left hip. Pupils dilated.
Weak and anaemic. Restless, constantly in motion. Would not reply
to questions. " I am nothing but straw, I have no name." " They
turned me around when they brought me here." "I can't do nothing."
Tongue clean, bowels constipated. Arsenicum was followed by Rhus
3rd.

July 11 — Restless all night. " Oh please, these things don't belong
to me." July 12 — Slept better. Eats well when fed with a spoon.
Temperature 97.1. July 13 — Temperature 96.6 ; pulse 84. Says it
is years and years since she ate anything. " I have been in this room
ten years — years before I was born." Still much depressed and weak.
Seems stronger though than when admitted, and not so restless. Time
seems too long. Cann. ind. 6 x every two hours. July 14 — Talks
better, stronger; temperature 96.8. July 15 — Restless, anxious
and noisy. For the next three days the temperature averaged
97 ; very restless, talking. July 19 — More restless. " Oh, don't,
for pity's sake, don't." No one was near when she said this. July
20th and 21st — Temperature 97.6; quiet; takes plenty of milk and
beef tea. July 22 — Thinks things are running around on the bed and
wall ; temperature 97.3. Stram. Ter Die. July 23 — Quiet ; pulse
72$ strong; seems better; temperature 97.2. July 24 — More quiet,
takes plenty of food daily; temperature 97.6. July 25 — Sees ani-
mals going around over her bed ; temperature 97.5. Stramonium
1st every two hours. July 26 — Quieter than usual; temperature
97.6. July 27 and 28 — Temperature 98.2 ; quiet ; groans some ; Cham.
1st every two hours. July 29 — Temperature 98. July 30 and 31 —
Temperature 98.3 ; quiet. Aug. 2 — Weight 88 ; says she cannot eat;
throat feels choked ; much quieter. Aug 4 — Says her throat is stop-
ped up and she can't swallow. Aug. 6 — Talks pleasantly. Aug. 7—
Talking much more rational ; stronger ; eating nicely and feeding
herself ; gains strength daily ; cannot remember clearly about things
which happened before she came in. Aug. 13 — Up and dressed for

Bureau of Mental and Nervous Diseases. 161

the first time ; very cheerful. Aug. 20 — A little nervous but gaining
nicely. Aug. 21 — Menstruating ; discharges profuse and dark ; no
clots or unusual pain ; slight headache and general soreness. Am. 1st
every two hours. Aug. 22 — Became excited on receiving a letter from
her husband. Aug. 23 — Quiet and mind clear. Aug. 24 — Says every-
thing is confused in her mind ; hesitates in talking ; lips somewhat
tremulous. Aug. 26 — Feeling better. Aug. 29 — Says she gets pretty
well bewildered about the days. Sept. 2 — Weight 95. Sept. 6 — Mind
still mixed. Sept. 9 — Thinks she eats too much and too often ; much
less confused. Sept. 10 — A little better. Sept. 15 — Worrying less
and is less confused. Sept. 18 — Doing nicely. Sept. 21— Not so con-
fused. Sept. 23 — Slept poorly ; head feels bad to-day ; confused feel-
ing in the back of the head. Mac. 3rd every two hours. Sept. 24 —
Cold in head ; hoarse ; soreness in the chest. Sept. 25 — Cold no bet-
ter ; throat feels fuzzy and thick. Sang. 3rd every two hours. Sept.
26 — Better. Sept. 27 — Mind clear. Sept. 28— Says she is going to
get well. Oct. 1 — Wakes at three a. m. ; bowels sluggish ; eats well
but not hungry. Merc. 3rd. Ter. Die. Oct. 2— Weight 109. Oct, 4.
— Is gaining and wants to go home. Oct. 5 — Improving steadily.
Oct. 6 — Played on the piano to-day ; bright and cheerful. Oct. 10 —
White, profuse leucorrhoea ; pain in the back. Calc. carb. 3rd. every
two hours. Oct. 15 — Toothache between eight and nine every night.
Merc. 3rd every three hours. Oct. 19 — "I feel first rate." Oct. 22
— Menstruating ; head feels queer. Oct. 23 — A feeling of drawing
in the top of the head with a sensation of heat that comes and goes.
Bell. 3rd every hour. Oct. 24 — Head better ; toothache at times.
Oct 26 — Seems entirely recovered mentally. Nov. 4, 1886 — Paroled ;
weight 120 pounds ; left with husband. Aug. 15, 1887 — Discharged
recovered.

Here is a patient who for about eleven years has been steadily enter-
ing the neurasthenic state. Her lowered temperature, her weakened
pulse, her loss of flesh, her lack of energy, her pallor of countenance,
and her depression of spirits, all bore evidence of the impoverished
and de-energized condition of the great nervous centres. To treat
successfully such a case amid the toiU and worriments of home seemed
to be an impossibility. Her restoration began when she was removed
from home cares and home irritations and consequent nerve exhaus-
tion. Once away from home and secluded from anxious friends, she
was placed in bed and afforded absolute rest. She was given an abund-
ance of easily digested food. When we consider that the human body
is composed of about eight-tenths water, we can readily understand

162 Bureau of Mental and Nervous Diseases.

how it is that liquid diet tends to rapid recuperation of exhausted and
neurasthenic patients. For medicine, this patient received from time
to time the indicated homoeopathic remedies, and by the effects of
these remedies we believe that a return of health was promoted. As
soon as the physical strength was restored in this case, the spirits of the
patient resumed their normal elasticity, thus proving once again that
a sound body is the only natural and substantial home for a sound and
cheerful mind.

EXPERIENCE IN THE MANAGEMENT AND
TREATMENT OF NEURASTHENIA.

By George E. Gorham, M. D.

ALBANY, N. Y.

If there be a disease, the management of which is trying and tedious
to the physician, and discouraging to those seeking relief, it is that
generally known as nervous exhaustion. Whether it be named neu-
rasthenia, hypochondriasis, spinal irritation, spinal anaemia, crankism
or nothing but nervousness, the symptoms of all have the same general
characteristics. I need not take your time to relate them here ; we
have all heard them. The pathology of these cases is said to be
obscure, but many hypotheses are formed to account for the various
symptoms of which these patients complain.

Perhaps the most prominent theory is exhaustion of the nervous
centres ; and upon this theory the so-called nervous tonics, the different
phosphated compounds, are bought and taken in large quantities by
nearly all neurasthentic patients, and far too often they get no further
advice from their physician than to take Fellows' Hypophosphites,
Crosby's Vitilized Phosphates, or some similar compound. Perhaps
they are laughed at as they pour forth their tale of woe, and told that
it is nothing but nervousness — a term which would be nearer a correct
diagnosis if it were put, something with nervousness.

To assume that exhaustion is the cause, and tonics and stimulants the
treatment for these cases, is as easy as it is common with the busy practi-
tioner ; but in my hands it does not cure. To laugh at and ridicule a
patient does not cure, and is often a cruel thing to do. That patient who
comes to us filled with morbid fear, is restless in mind and body, startled

Bureau of Mental and Nervous Diseases. 163

by every sound and cries at trifling things, can be calmed and comforted
and perhaps put on the road to recovery at that very visit by simply
admitting to that patient, and to our own mind as well, that he is sick,
and not think and try to make him believe he is simply nervous, fussy
or foolish. There is a cause for these conditions of mind and body,
and to tell patients so, and then make intelligent and earnest efforts to
find and remove it, gives them a comfort and a ho^e that will enable
them to bear patiently the flying pains, the palpitating heart, the tor-
menting fears or the sad and painful emotions, until we have removed
or alleviated the exciting cause, when they will slowly but surely grow
into a degree of health gratifying to us and surprising to them.

The causes would be divided, I suppose, after the manner of medical
authors, into predisposing and exciting. I will omit mentioning the
former. The latter, the exciting causes, may be divided into two
general classes — mental and bodily.

It is often difficult to find the mental cause, for the patient is slow to
admit some secret sorrow or burning anxiety that is constantly harrassing
his mind ; but they are frequent, and often found in some business com-
plication, or among the many trials incident to social life. Unfortu-
nately the physician can do little to remove these causes, but he can do
much by kind words and encouragement to help the patient to bear
them.

The Bodily Causes, I have most frequently found within the pelvic
cavity. In man an hypertrophied prostate, a chronic urethritis, a
stricture or a phimosis may make him a wretched hypochondriac.
Morbid conditions of the rectum, piles, fissures, strictures, and pockets
and papillae, as described by Pratt, are often a constant source of irri-
tation which exhaust the whole nervous system. The abuse of the
sexual function by masturbation or too frequent intercourse, is a cause
too well known to need mention. In woman the same conditions of
the rectum often prevail, while any or all of the morbid conditions
known to the gynaecologist may be the exciting cause of a persistent
neurasthenia.

The Treatment, which has been quite successful in my hands, has
been removal of the exciting cause when possible, rest properly pre-
scribed, sometimes an hour each day, sometimes weeks at a time and
sometimes an occasional day or two off from business, proper fcod
eaten slowly and regularly, sufficient sleep, and the discontinuance of
nerve tonics and stimulants of all kinds, excepting sometimes tea and
tobacco in moderation, where they have* long been accustomed to it,
(never allowing smoking), and the indicated homoeopathic remedy.

164 Bureau of Mental and Nervous Diseases.

The ones which have most often served me well are Nux. vom., Igna,
Silicia, Cal. carb. Cal. phos., Verat. vir., Cactus grand., Hyper, Scutel-
laria, Sepia, Phos. acid and Sulphur. The indications for these and
many other important remedies may be found in that -most excellent
article " Therapeutics in Spinal Irritation," by F. F. Laird, published
in the North American Journal of Homodopaihy. The benefit
derived from the removal of local irritation is shown in the follow-
ing cases :

Mr. L., aged 64 years, has for several years complained of being
tired, being unable to go through the day without lying down for rest,
sudden noises annoyed and pained him, he was emotional, crying with-
out cause, and a firm conviction that he had but a few months to live
had settled upon him. His face showed a tired and haggard expression
and his sleep was unrefreshing — always disturbed by distressing dreams.
He said he was worn out. The removal of a large internal hemorrhoid
was followed by entire relief. He says it made a new man of him, and
so it did. The tired look is gone, the sleep is quiet and refreshing, the
hope and ambition of his earlier manhood have returned to him, and
he has endured a hard, hot summer's work with no return of his
trouble

Mr. W., aged 29, unmarried, a banker, sought relief of many dpc-
tors, tried rest and change of climate, and the popular nervous tonics
were taken without benefit His palpitating heart, his imaginary con-
sumption, his wild, restless feelings when he attempted to work at
his desk, and his great sense of exhaustion about 11 a. m. continued.
Slitting up the fore skin for a congenital phimosis cured this man in
one month, and he has had no return of his trouble now four years.

Mr. H., unmarried, aged 28, an editor, complained of dizziness, ina-
bility to do bodily or mental work, constant restlessness, poor sleep,
pains in the knees and pain and soreness in each tuber ischii occasioned
nocturnal emissions and a whitish sediment in the urine which he wa9
hourly examining, carrying a bottle in his pocket for the purpose. The
point of irritation in this man was found in the prostatic urethra, which
the passage of graded steel sounds and the administration of Thuja
12 x relieved, and his pains and nervous symptoms disappeared. He
gained 15 pounds in three weeks, and has remained well for three
years.

Mr. M., an excessive smoker, met some reverse in business and began
to worry. He soon became irritable, nervous, and slept but little. He
complained of painful emotions, "nobody could imagine how badly he
felt." His legs felt numb, his sexual power was wanting, and he was

Bureau of Mental and Nervous Diseases. v 165

very restless. Morbid fears came in to add to his torment, he would
not walk, sit or ride alone. He became depressed and suicidal. For
two years he rode or walked, and talked and cried almost constantly,
excepting three to five hours sleep a day. He was a large, red faced
man and looked the picture of health. Yet his trembling hands, his
constant restlessness and his rambling conversation, often crying as he
talked, told of trouble somewhere. The exciting cause in this case was
a mental one, and every one of the eminent specialists whom he had
consulted had advised tonics or stimulants, or both, and exercise. He
had exercised and stimulated until he was a bundle of exhaustion and
hyper-sensitive nerves, without hope or will power, a victim of his ever
changing emotions. At this stage he took the case into his own hands
by an attempt at suicide. I was then called and prescribed continued
rest in bed, which the patient said he could not take. He was
enforced for three days and Verat. vir. 3 X given and stimulants taken
away, which soon changed our patient to a quiet, tired and sleepy man.
He lay quietly in bed for three weeks, eating and sleeping well, when
he was allowed to go to the sea shore, where his improvement went
steadily on for a month. He spent the summer on a farm and then
returned to the city, where he has been in his business for two years.
Ign. 3 X did more to quiet this man than all the Bromide, Chloral and
other hypnotics he had ever taken.

Unfortunately we cannot locate and remove the cause in all cases as
successfully as in those just cited. We then have to call to our aid
massage, electricity, diet, rest, exercise and homoeopathic medication.
The following case will show what can be done with the true
sirnilimum :

Mrs. Y. consulted me in May, 1887, after having been under
treatment for 6 months for u nervousness." I copy from my case book:
Mrs. V., aged 63, mother of six children, ceased menstruating at 56, is
fat and apparently well nourished ; digestion good, bowels regular and
not an ache or a pain. Pulse and urine normal, but complains of great
weakness. If she reads cannot remember what she is reading, a walk
of two blocks tires her. Visiting tires her so that she must leave the
room. Sleeps badly and has a fear night and day that something
will happen to her family. A fat woman with muscular and nervous
prostration.

Failing to find any local cause, I gave her Silicea 6 X trit. 4 times a
day. Reported in a week, better; continues, the next week much
better; continues remedy. In one month's time she could read, visit

166 Bureau of Mental and Nervous Diseases.

and walk a fair amount for one of her age, and enjoy it. She counted
herself well, and the little powders a wonder.

Silicea will cure sweating feet. Silicea will control too rapid forma-
tion of pus. It cures also some forms of bone trouble, and it does it, I
believe, by its power to correct that weakened or depressed condition
of system which tends to the development of such troubles. It cured
Mrs. Y. in the same way. It is often indicated in cases of neurasthenia
and muscular weakness, and when it is I have found it more valuable
than all the stimulants, nerve tonics and phosphorous compounds made.

REPORT

or THE

BUREAU OF LARYNGOLOGY,

L. A. Bull, M. D., Chairman* Buffalo,

Des. George M. Dillow, - Now York OJty*

Clarence E. Beers, - . ♦ Now York Cit\\

Malcolm Leal, Now York City*

J. Montfobt Schley, .... Now York OUv.

J. W. Dowling, Jr., .... Naw York Oit)\

With the invited co-operation of

Prof. J. W. Dowling, - New York City.

Dr. George E. Shelton, - - New York City,

LOCAL TREATMENT OF LARYNGEAL, PHARYN<
GEAL AND NASAL TUBERCULOSIS.

By J. M. Schley, M. D.,

NEW YORK CITY.

During the last decade little advance has been made in the satisfactory
treatment of laryngeal ulcerations of a tuberculous origin. In fact,
phthisis now, as then, remains one of the most obstinate of chronic
maladies to bring to a standstill or to cure. When we come to man
up our personal experience in this trouble we must first of all divide
the subject matter into three parts. First, an accurate diagnosis ;
second, prognosis ; third, treatment.

I will admit that in the incipient stage or stages of laryngeal phthisis
some difficulty as to an absolute diagnosis is present ; we may readily
confound it with a chronic larngitis, with its accompanying infiltration,
a lupus (primary), a carcinoma, and more especially syphilis. There is,
however, in all these diseases one fact that ha* itupn;H*<;d ma mora

■

168 Bureau of Labyngology.

than any other, and that is the invariable presence of tubercular
deposit in the lungs when we find tubercle in the larynx, pharynx or
nares. This is a point upon which I have exhibited much patience,
and would not say a man had a phthisical larynx if his lungs were
healthy. The infiltration in the pulmonic substance may not be great
— may be unilateral — but it is to be found if we search again and
again minutely, if it be necessary so to do. In 95 per cent, of those
coming under my personal care it was where the third stage of phthisis
wa6 already present when laryngeal symptoms first presented them-
selves. Should I meet with a case presenting most of the macroscopical
appearances of laryngeal phthisis, and no lung complication exisiting, I
should first exclude beyond all doubt any syphilitic taint before declar-
ing myself in favor of a tubercular state. Most laryngologists experi-
ence the difficulty, sometimes from occult changes alone, in discrim-
inating between a luetic and tubercular affection of the larynx. I have
never witnessed phthisical ulceration of pharynx and nose without
marked evidence of it elsewhere in the respiratory tract. Primary
carcinoma and lupus of larynx belong to the list of curiosities.

The oedema, the anaemia (generally), the infiltration, the points
attacked by preference, the perichondritis, the superficial erosion, rap-
idly spreading into an ulceration, with destruction of the soft and neigh-
boring parts, is a familiar story to many of us. Now then, we must
have no half-way opinion of our diagnosis, but must be absolutely cer-
tain of our case before we may say this and that of an incurable mal-
ady. This very day a gentleman presented himself in my office whose
larynx I examined eight years ago. He has now, and had then, con-
solidation of the upper lobe of his right lung, and the same to a much
lesser degree in the left. The bases of both were emphysematous.
His epiglottis on both surfaces, the walls of the larynx, true and false
chords and upper margin of trachea were intensely red — congested —
no infiltration or oedema as yet, but a quantity of tenacious, ropy
mucus was visible. I could not claim with all fairness that he was
suffering from laryngeal phthisis, for he was not. Two or three of
the most important pathological appearances were entirely wanting,
yet some specialist would eagerly have claimed a cure here. A few
weeks in the mountains, without local treatment, speedily relieved the
congestion, aphonia, etc., and he has so remained until this hour.
First, then, let us be sure that we have a phthisical larynx.

Prognosis. — In my own experience I have never seen a case of
genuine tuberculous laryngitis get well. They invariably die. True
it is, they may linger for weeks and months, with days of improve-

Bureau of Laryngology. 169

ment and with days of aggravation, until death closes the scene. 'About
5 per cent, suffer from this complication of tabes, and I think among
the lower classes the per cent, may run a little higher.

Local Treatment, though bringing relief and comfort to the patient,
is not,, curative in any sense of the word. Caustic or harsh local
treatment must he condemned. The remedies most useful in the form
of a spray, powder or liquid, are Morphia, Iodoform, Cocaine, Lactic acid,
an oily solution of Menthol, Peroxide of Hydrogen, and the Balsams.
The galvano-cautery, and scraping away deposits uijjer Cocaine
and then applying Lactic acid in a 15 or 20 per cent, solution are
highly 6poken of recently, also subraucus injections of Lactic ac. in
larynx. When mucus clogs the way it should be removed by brush or
spray before any local treatment is commenced. Of all these external
applicants Lactic acid and Menthol hold out to us the most encouraging
results as to a cure, if there be such a thing. We know fairly well
what and how much each one of the above cited drugs may do. Some
people do not tolerate Cocaine and we often have to resort to other
remedies.

General treatment must naturally be carefully supervised.

Among homeopathic remedies we note Belladonna, Apis m., Lach,
Cantharis, Mercury, Phosphor., Causticum and Calc. phos. They often
render material help in our treatment.

With the investigating turn of mind that seems now to pervade the
whole profession I do not think that I overstate the matter when I
claim that in the future phthisis of the larynx and lung will be safely
classed among the curable chronic diseases.

ON THE CONDITIONS OF THE LARYNX REQUIR-
ING LOCAL TREATMENT.

By Malcolm Leal, M. D.,

NEW YORK CITY.

When our chairman notified me that he expected from me a three-
minute paper on the conditions of the larynx requiring local treatment,
I was inclined to reply in the language of the famous essay on The
Snakes of Ireland, " There are none." Further reflection decided me
in giving briefly my own experience with local treatment.

170 Bureau of Laryngology.

I am inclined to believe that local medication is seldom necessary for
the completion of a cure, but that it is often desirable for the accelera-
tion of its progress. Local applicationfe, exclusive of the mechanical
or surgical procedure so often necessary, have for their object, either
cleanliness, antisepsis, local or systemic absorption, or two or all of
these combined.

On reviewing my case records I find that local applications have
been made with benefit almost exclusively in those conditions of the
larynx characterized by loss of tissue. Laryngeal ulcerations from
whatever cause appeared to demand local treatment. Those of syphil-
itic origin especially were always combatted more successfully when
local measures supplemented the constitutional. Especially valuable
were the cleansing effect of the Hydrogen peroxide and germ-destroy-
ing power of corrosive sublimate. Tubercular ulcerations were often
treated by cleansing and insufflations of Iodoform, or in two cases by
friction with Lactic acid ; but the only cures (and these of the ulcera-
tion only) occurred in cases where the ulceration was of small extent,
and in those the cure seemed to be due to the remedy given internally,
which was, in each of the three cases recorded, the Nitrate of Mercury.
In two cases of malignant ulceration local analglesia and deodorization
were produced, that the condition of the patient might be more
tolerable.

One case of typhus laryngis received no local treatment and recov-
ered. My personal experience does not extend to cases of laryngeal
ulceration from other causes than those mentioned, but judging from
the behavior of similar conditions affecting other organs, I should
expect to rely on local treatment in lupus, and to a subordinate extent
in traumatic ulcerations. Inflammmations of the laryngeal tissues not
terminating in ulceration have seldom called for local interference
other than the application of thermal regulators, as steam, ice, etc.,
except in those cases attended by production of false membrane, where
antiseptics and solvents were occasionally used, and in those cases where
atrophic or hypertrophic conditions succeeded the acute attack. Of the
former, a noteworthy case of laryngitis sicca, so-called, is among my
records :

A lady, aged about thirty-five, was found to have an atrophic condi-
tion of the mucous membrane of nose, larynx and upper trachsa. She
had been treated for a post-diphtheritic paralysis of the vocal cords
some years before, and supposed that the paralysis had returned, as she
was perfectly aphonic. Examination showed that the vocal cords were
coated with inspissated discharge so firmly adherent that it had to be

Bureau of Laryngology. 171

detached with a probe when first seen. On its removal her voice became
normal, though somewhat weak. In twenty-four hours the condition
was as before, and it was only after several weeks daily treatment that
spraying the parts became sufficient to remove the crusts, and at the
end of four months she was able, by home treatment, to remove the
crusts, which then formed more slowly. It is probable that she will
never recover sufficiently to discontinue the local measures for relief.
Two cases of laryngeal neoplasm (benign) are among those recorded,
where local treatment was not used, and where the growths gradually
disappeared while Causticum and Arnica were being used internally.
Of the so-called chronic laryngitis I have had but few cases, and as
these drifted away from active treatment their records are not specially
instructive. While much more might be said of these and other cases,
this brief record of personal experience will answer the purpose of
provoking discussion, and serve to introduce the thesis that non-me-
chanical local treatment seldom determines the cure.

Discussion.

Dr. Beldin : Wish to inquire whether physicians present have tried
Electricity Oxygen gas, or rectal gaseous enema in larynxgeal phthisis ?
Whether tuberculosis is contagious or not ? Have known several
cases where a healthy person slept in the same bed with tubercular
patient and contracted tuberculosis themselves.

Dr. Bull : Investigation by French physicians show that chickens
have become infected by eating sputa, and persons who have eaten
these chickens have taken tuberculosis.

Dr. Boooook : In incessant cough with night sweats, benefit has
been derived from Myosotis, tincture in water.

Believe contagion due to the absorption of perspiration from the
sick person, and also from nervous sympathy.

Belated case of wife and made a plea in behalf of curability of
phthisis. Thinks the craving for acid should give an indication.

Has found Phos. ac. of benefit. Calc. phos. will relieve night sweats
surely.

Dr. Schley : It is sometimes difficult to differentiate between
syphilitic and phthisical conditions of the larynx.

Asked for reports of internal medication.

172 Bureau of Laryngology.

Thought Dr. Gorham was mistaken in the subject of morning dis-
cussion, which was laryngeal phthisis and not of the pulmonary variety.

When we come to speak of the curability of phthisis pulmonum we
must divide it into its two varities — catarrhal and fibroid. In the latter
variety life is prolonged indefinitely if one lung be alone involved ; in
the catarrhal, where both lungs are affected, the difficulty is more seri-
ous and less easy to cure.

Dr. T. M. Strong : The results of medication in the treatment of
cases of consumption in our Ward's Island hospital are not very satis-
factory Our patients are the victims of alcoholism or starvation and
exposure. They come to us broken down in health and spirits. What
palliating effects we obtain are due to the use of remedies like Phos.,
Silic., Calc. carb. and phos. and allied drugs. Cod liver oil is used in
a few cases as an adjuvant.

Our wards are overcrowded, and patients suffering from phthisis in
all its forms fill them, but so far as these circumstances may have any
influence we fail to find the slightest evidence of its transmission or con-
tagiousness.

We do not use any direct means of disinfection ; Carbolic acid crude,
however, being used once a week on all the beds of the ward as a pre-
ventative or destroyer of vermin. Lately we have been using the
" crude sanitas" in the form of a spray, and find it a very agreeable
agent, filling the air with the aroma of the pine woods Opportunity
has not been given to test it as to any special effects upon individual
cases.

Dr. Terry : In chronic bronchitis, in serious cases with high tem-
perature, greenish expectoration, the inhalation of the vapor of Sul-
phur has been used with marked benefit.

Dr. Shelton : Have tried all local means and used remedies, and
have never seen any permanent results in a case of genuine phthisis of
larynx. In cases that were cured I believe diagnosis at fault. Vapor
of a solution of Hydrastis and Glycerine with Carbolic acid was useful
in relieving pain.

I believe phthisis of larynx secondary to phthisis of lungs.

REPORT

* BUREAU OF CLIMATOLOGY,
usse.t

H. M. Paine, M. D., Chairman, - - - A

Dks. E. W. Bryan,

J. N. Tilden, Pt

George Allen, W

F. Lengoenhaqer. U

THE PURIFICATION OF WATER.
By George Allen, M, D.,

WATERVILLE, N. Y.

Dr. Parkes, in his famous work on " Practical Hygier
"Tlie supply of wholesome water in a sufficient quantity i
mental sauitary necessity."

Dr. J. S. Billings, in Pepper's " System of Medicine," wri
all the various preventable and movable causes of disease to
attention of the physician engaged in practice in small t
rural districts is directed, it will usually be found that the v
ply is the most important, because it is in these localities
most liable to become contaminated in such a way as t<

The main sources of impurity and danger in potable wat
in the presence of organic and mineral matters in suspensioi
tion ; also certain deleterious, gases notably hydrogen sul|
various products of organic decomposition; and also, in
cases, of the specific germs of infectious diseases.

The presence of chlorides in excess is regarded as evident
tamination by urine or other animal excreta, and water s
inated is justly regarded with suspicion.
* No report from Bureau of 1B9T.

174 Bureau of Climatology.

The first step toward obtaining pure water should be the removal of
the sources of contamination. Removal of the cause does not, however,
at once remove the defect. Running water and living springs will soon
free themselves of impurities if no more are added, but wells fed
solely by surface water require considerable time to elapse before
they will cease to be contaminated from a soil already saturated with
foul matters. Such wells should not be used for a long time when
known to contain contaminated water, and never until they have been
thoroughly cleaned.

The agencies affecting water unfavorably will, in a majority of
instances, be found in defective drainage, or the near proximity of
privies, cesspools or garbage heaps to the sources of water supply.

The manner of correcting these evils will suggest itself when the
features of individual cases are made known. It is the purpose of
this paper to describe methods of rendering impure water wholesome.

This may be accomplished by chemical processes and reagents or
by filtration.

Chemical Processes. — Of these distillation should, perhaps be men-
tioned first, on account of the absolute purity of the product obtained.
Distilled water is not, however, an agreeable beverage, being flat and
insipid to the taste and not easy of digestion. Should necessity arise
for its use it should be thoroughly agitated with air, and the addition
of small quantities of calcium carbonate and of sodium chloride will
render it more palatable. Most ocean-going vessels now carry a dis
tilling apparatus for distilling salt water in case of necessity.

Exposure of Water, in divided currents, to the action of the air is
another chemical process of water purification, the rationale of which
consists in subjecting water to the oxidizing influences of the atmos-
phere. This plan is adopted in many cities for purifying water in
connection with filtration, the water being thrown into the air by a
fountain and falling into a minute spray. The water absorbs oxygen
and is rendered more sparkling and palatable, deleterious gases are
dispersed and a portion of the contained oxygen matter oxidized.

Boiling as a method of purifying water, is one of considerable
importance. It disposes effectually of ordinary impurities. Very
hard water is rendered softer, hydrogen sulphide is expelled, any
contained iron is diminished in quantity, and the amount of organic
matter largely destroyed.

Whether boiling destroys entirely septic germs is doubted by some,
although Parkes thinks it hardly probable, and Sanderson stfys that
septic bacteria are killed at about 230° F. Therefore, to insure the

Bureau of Climatology. * 175

destruction of disease germs, water should be superheated. Most fun-
gus spores are killed by boiling.

Precipitation^ as a method of purifying water, has various modes of
application.

In calcareous waters the addition of about six grains of alum to the
gallon throws down a bulky precipitate of calcium*sulphate and alu-
minium hydrate, which entangles and carries with it snspe nded matter.
This method, however, cannot be depended upon to destroy septic
germs.

The addition of lime to water acts in the same way by precipitating
calcium carbonate, iron and a certain proportion of dissolved organic
matter.

Sodium carbonate, with boiling, also throws down calcium carbonate,
and a little lead, if that metal be present in solution.

Potassium permanganate purifies water by the precipitation of man-
ganic oxide, arising from the oxidation of organic matters, which are
thus rendered innocuous. This action is said to occur only in warm
solutions. This salt also removes the odor from water that has under-
gone fermentation. " Condy's fluid " is the preparation usually recom-
mended for this purpose, although Professor Chandler speaks of using
the crystalized salt, and advises travelers to carry a small vial of it
for the purpose of purifying suspected water. It should be added
little by little, until after standing thirty minutes, a slight pinkish
tinge remains. All organic matter has then been oxidized. A slightly
yellowish color may remain, due to the manganic oxide, and this may
be removed by the addition of a little alum.

Perchloride of Iron cleanses water of particles of clay in suspension,
and has ako considerable oxidizing influence upon organic matters.

Charcoal is an agent generally supposed to possess considerable
activity in purifying water. It is very effectual and rapid in its action
upon decomposing organic matter. Its action on fresh organic matter
is less certain, so that it cannot be implicitly relied upon to destroy
disease germs contained in water. Moreover, if the charcoal is allowed
to remain in contact with the filtered water, it, after a time, gives up
again organic matter already removed. This suggests a caution against
throwing loose charcoal into foul cisterns, and of using charcoal filters
in cisterns so constructed that the medium is in constant contact with
the water, as the purpose of the filter is thereby thwarted.

This leads to the consideration of the subject of filtration as a method
in very general use for the purification of water.

Filtration is by some supposed to be limited in its action to sus-
pended impurities, mud, sand, and various organic matters in suspen-

176 Bureau of Climatology.

sion. Professor Chandler so defines it in his article on " Water," in
Johnson's Cyclopaedia. Parks, on the contrary, assumes that a prop-
erly constructed and used filter destroys organic matter in solution, and
hence is a water purifier in its strict sense, and not merely a strainer,
which Chandler's definition would make it.

Sand and grafel enter into the composition of many varieties
of filters. These media are in general use for filtering the water
supply of cities, employed alone, or in addition to other methods
of purification. When used for this purpose a layer several feet
in thickness is constructed from coarse stone, coarse gravel, fine
gravel and sand, arranged in the order named. Through this the
water percolates, and in so doing is deprived of all solid matter.
Sand also arrests, to a limited extent,, dissolved constituents, both
organic and mineral; but this action ceases after a time and the sand
requires washing. It is uncertain whether sand oxidizes organic matter
in filtration, though Parkes believes that some amount of oxidation is
probable. For use in filters white sand is the best ; it should be care-
fully washed, and if possible, heated to redness before use.

Charcoal, both animal and vegetable, is much used in the construc-
tion of filters, either by itself or forming a layer in a filter where sand
and gravel are also used. Like sand, it removes suspended and dis-
solved organic and mineral matter, but its powers over matters in solu-
tion diminishes with use, and ceases entirely after a time. Parkes
gives it as a rule that the charcoal in filters should be cleaned or
renewed evGry three months. The caution already mentioned against
allowing filtered water to remain in contact with the charcoal forming
the filtering medium should be borne in mind when selecting a filter.
If the filter is so constructed as to permit of this it is of no value.

Spongy Iron is a substance highly spoken of by Dr. Parkes as a
filtering medium. It is obtained by roasting hematite iron ore. It is a
porous metallic iron, and not unlike charcoal in appearance. It arrests
organic matter in suspension and oxidizes organic matter in solution.
It imparts a little iron to the water, but beyond this yields nothing.
Water filtered through this medium may be stored for a long time
without undergoing any change. In this particular it is superior to
charcoal ; for water filtered through charcoal soon undergoes changes
and shows the production of living organisms.

The so-called u Block Filters" are composod of various substances
moulded into a block, through which the water percolates.

Essentials of a Good Filter. — Dr. Parkes gives the following :

1st. " That every part of the filter shall be easily gotten at for the
* cleaning or renewing the medium."

*£

Bureau of Climatology. 177

2d. " That the medium have a sufficiently purifying power, and be
present in sufficient quantity."

3d. " That the medium should yield nothing to the water that may
favor the growth of low forms of life." This essential is not complied
with by animal charcoal in a loose condition.

4th. " That the purifying power be reasonably lasting." Spongy
iron is said to last longest, though much depends on the relative
impurity of the water to be filtered.

5th. " That there shall be nothing in the construction of the filter
itself that shall be capable of undergoing putrifaction, or of yielding
metalic or other impurities to the water." This demands that noth-
ing organic thall be used in the construction of the filter, and that
metals shall be protected from the action of the water.

6th. " That the filtering material shall not be able to clog, and the
delivery of water shall be reasonably rapid."

All filters should be frequently cleaned. The greater the impurity
of the water the oftener will this necessity arise. Charcoal is the best
cleansed by heating it to redness under cover, or by passing through it
Condy's fluid (permanganate solution,) until it comes out a distinct
pink color, then expose to the air and sun, and afterwards wash with
distilled water.

Block filters cannot be easily cleaned, though pumping air through
them in a reverse direction and the employment of Condy's fluid, has
been recommended.

Spongy iron may be cleaned by heating to redness.

All strainers that cannot stand the action of heat should be fre-
quently renewed.

Filtering is a system of purifying water in general domestic use. It
is by no means a system devoid of danger. If constructed of improper
materials, or used in an improper manner, filters are unsafe. If used
too long without cleansing they may become actual sources of disease.
All the impurities taken from the water remain in the filter, and as no
one would drink water that had passed through a dirty strainer, no
more should they think of using water drawn from a dirty filter ;
and yet this is done by intelligent people.

Filters are often used year after year without cleaning or renewing
the filtering medium, the owners all the time supposing that they are
using pure water, because it is filtered ; on the contrary they are often
fostering the very evil they seek to avoid.

This subject is one of many upon which the laity need information,
and from no informant can the information be given more effectually
than by the physician.

REPORT

OF THE

BUREAU OF HISTOLOGY

Fred. S. Fulton, M. D., Chairman, - - New York City.

Drs. W. Storm White, New York City.

A. Wilson Dods, - Fredonia.

J. Montfort Schley, - New York City.

J. W. Dowling, Jr., - - - - New York City.

♦Microscopic anatomy of the c arcinom ata

By A. Wilson Dods, M. D.,
fredonia, n. y.

When Dr. Fulton invited me to contribute a paper on the above
subject I felt that although I could offer nothing new in regard to the
histology of the carcinomata, yet I might possibly be able, by present-
ing in compact form those points of structure which characterize this
group of tumors, to save to some one a portion of the labor I have gone
through with in order to become familiar with their histology, and at
any rate I should be doing the work assigned me by the chairman of
the bureau. It is, therefore, with a full appreciation of the fact that
I may be, and very probably am, " Carrying coals to Newcastle, " that
I present this paper to the Society.

As other members of the bureau will consider the etiology and
clinical history of these new growths, this paper will be confined as
closely as may be to a description of their appearance as seen in the
pathological laboratory and an endeavor to illustrate this by the aid of
photo-micrographs. As a means of conserving your time as much as
possible I shall omit the details of the preparation of the tissues for
microscopic examination, referring to Dr. Geo. Sims Woodhead on

* Photos referred to were exhibited at Meeting- during reading of Paper.

Bureau of Histology. 179

Practical Pathology and a paper of my own, " Practical Hints for the
Examination of New Growths," which I had the honor to read before
the Horn. Med. Soc. of Western New York last January, and which
was published in the March number <5f the North American Journal of
Homoeopathy, for a full description of all the steps necesssary to be
gone through before the tissue is ready for the microscope.

Before entering upon this subject matter proper it will be well to
mention that there are no new tissue elements introduced into the sys-
tem with which to build up the new growths, but that these forma-
tions are composed of elements which are normally found in the body
at some period of its development. This statement would appear to
be superfluous, but one so often hears of " cancer cells " that it is well
to combat the error on every occasion, for it would be absolutely
impossible to say, on a microscopic examination alone, whether the
epitheliaform cells found in " cancer juice " were " cancer cells "
or not. It is the tissue elements taken together of which a tumor is
composed, their amount, proportion and arrangement, which deter-
mines its classification, and not the presence of any one particular form
of cell. What I wish to make clear is, that although the true nature
of a tumor is always better known after a microscopic examination,
it would be folly to assert that its nature and proper classification
could always be determined by such an examination, alone and
unaided. It is always wise, and in some cases absolutely essential, that
the clinical history be known, e. g., in the case of simple granulation
tissue and round celled or mixed sarcomas. Without the clinical history
it would many times be impossible to distinguish them, as both are
made up of young connective tissue cells, embryonic blood vessels,
and so on.

The carcinomata, or epithelial tumors, may be defined as new
formations made up of cells of epithelial type, with little or no
intercellular substance, situated in irregular masses in the alveoli of
a connective tissue stroma, which last has well developed blood vessels
running through and supported by it. If it be further understood
that these elements are in excess of the normal amount found in the
tissue, are of high vegetative power and great malignancy, we will have
a sufficiently clear conception of their nature for our purpose.

There are four varieties of carcinomata, viz : scirrhus, eucepha-
loid, colloid and epithelioma. I have adopted this classification rather
than that given by Ziegler, which has, in addition to the above, simple
carcinoma, carcinoma myxomatodes, cylindroma c, giant-celled (or
myeloid) and melano-carcinoma, as these latter seem to be mere modi-

180 Bureau of Histology.

fications of one or other of the former, depending on rapidity of
growth or degenerative changes, rather than any real difference in
"Structure, and also because a multi plication of names only leads to
confusion. The above objection might be urged against making a
separate variety of colloid, and with some show of reason ; but as all
authorities class it as a separate variety, and as it is so often found as a
distinct tumor, I have thought best to speak of it separately.

The first three, scirrhus, encephaloid and colloid, are alike in their
general characteristics, their differences being in the proportion which
the stroma and cell elements bear to each other, in the character of the
epithelioid cells, and also in the condition of the stroma.

Take a section from the advancing edge of as scirrhus cancer and the
following may be noted : the infiltration of the adjacent tissues with
small round cells, indifferent tissue ; then the characteristic stroma
surrounding the alveoli, which in this part of the tumor contains well
marked connective tissue fibers and nuclei ; and lastly the cells filling
the alveoli, which it will be noticed are of distinct epitheliod form, and
also that some of them have more than one nucleus. Now examine
a section from the older part of the tumor near its center and it is at
once noticed that there is a large increase in the amount of the stroma
and that the alveoli are smaller and fewer in number. Closer inspec-
tion will show that the stroma is not only greater in amount but has
altered in character, having become more fibrous, and also that the
epitheliform cells in the alveoli have not only decreased in number but
are in various stages of fatty degeneration.

Encephaloid or medullary cancer differs from scirrhus in the
alveoli being much larger and more crowded with cells, and in the
stroma being more delicate and more of the connective tissue type,
less fibrous. (Photos. IV. and V.) Under a higher power (Photo
VI.) it will be seen that not only is the stroma very delicate and
cellular, but that the cells filling the alveoli have lost somewhat their
epithelioid character, are smaller and that there are more free nuclei, all
of which points to a more rapid growth.

Colloid cancer is really one of the last mentioned forms in which the
cells have 6hown a tendency to colloid or mucoid degeneration. The
points to be noted are the large size of the alveoli and the thinness of
their walls, also that the cells have either undergone or are undergoing
colloid degeneration. I am sorry that I cannot 6how photo-micrographs
of this variety as I am not in possession of a slide of colloid from
which to get the negatives.

The epithelioma form a distinct group of cancerous tumors, of which
there are two varieties — squamous and cylindrical or columnar.

Bureau of Histology. 181

Squamous epithelioma is found growing from the skin and mucous
surfaces, covered with squamous epithelium, and may 2 be said to be
characterized by branching finger-like processes of epithelium pushing
down between the papillae into the 'sub-adjacent connective tissue by
the so-called cell-nests, which appear in the section as^round or ovoid
bodies made up of conventric layers of flattened epithelium, the more
dense portions of which stain yellow when picro-carmia is the stain
used, and lastly *by the great increase of squamous epithelium at the
free margin of the tumor. (Photos^VII, VIII, IX.)

At the advancing margin of squamous epithelioma is seen the same
infiltration of the adjacent tissues with round cells as was spoken of
under scirrhus. This is well shown in Photos. X. and XI.

Cylindrical, columnar or glandular epithelioma has its origin in the
columnar epithelium of glands; most freqently perhaps in those'of the
intestine, but also in the uterine glands, in the liver, mamse, etc. If
the squamous variety may be said to advance by finger like processes,
or columns of epithelium, so in the columnar-celled the same mode of
growth may be assumed, except that in the latter case the columns are
hollow and lined by cubical or columnar epithelium. These in the
section (See Photos. XII. and XIII.) appear as spaces in the connec-
tive tissue stroma lined with a single row of columnar cells. Ziegler
segms to convey the idea that this lining is usually filled with epithe-
liaf orm cells, and although I have only once or twice seen such a speci-
men, 1 ^ would seem probable that this is the true appearance, as the
cells might easily be washed out in the manipulations of staining,
mounting, etc , and so give the section the appearance spoken of above.

Xnspiceqc tamquam in speculum in vitas omnium
Xuheo atque ex aliis sum e tie exemplum stbi.

— Terence.

department * IRecrologs

A W. Holden, A. M.. M D.,

NECROLOGIST,

Glens Falls. N. Y.

|tt gftemcrrtam*

TTbomas Jefferson petttt, Ob. TB>.
Cornelius ©rmes t Ob. 2>.
Jacob ©♦ pbtlip, /!>♦ 2>.
Hrtbur p. Jbollett, Ob. !>♦
%QVcn$o Ob. fsenson, /!>♦ 2>.
XHUHfam Denrg 1Ran&el, Ob. 2>.
Cbarles O. Glarft, Ob. W.

Thomas Jefferson pettit, m. d.,

FORT PLAIN, N. Y.

By H. M. Paine, M. D.,

Dr. Pettit was born in the town of Saratoga, Saratoga County, N. Y.,
July 4, 1817. He received a thorough English education in his native
county. By unremitting effort, working during the day and hard
study at night, he qualified himself for the profession of teaching. In
this capacity he filled many positions, both in his native county and at
Rome, Oneida County, N. Y., to which place he removed about the
year 1850, to accept the principalship of the high school.

Subsequently he was elected, after a stubborn contest, to the office
of superintendent of public schools, his opponent being the Hon. O. B.
Mattison, a well-known and popular politician of that period.

Incessant application to the arduous duties of his office precipitated
a prolonged illness, during which he was persuaded to make a trial of
homoeopathic treatment through the personal influence of Dr. S. 0.
Scudder, at that time one of the pioneers of the new system of practice.

After his recovery, and at the expiration of his term of office, he
entered upon the study of medicine under Dr. Scudder' s supervision,
and was graduated from the Philadelphia Homoeopathic Medical Col-
lege in the spring of 1854, and the following year from the New York
Homoeopathic Medical College.

In the summer of 1855 he removed to the village of Fort Plain,
Montgomery County, N. Y., where for more than twenty years he
enjoyed a large and lucrative practice.

He was stricken with paralysis in the winter of 1876, after which he
relinquished active professional duties, but was thereafter, for upwards
of ten years, able to maintain a remunerative office practice.

He died at Fort Plain, March 3, 1886, in the sixty-ninth year of
his age.

PEKSONAL CHARACTERISTICS.

He was upright and conscientious in all his dealings with his fellow-
men. He was an earnest advocate and zealous supporter of all
measures having for their object the promotion of temperance, morality
and religion in the community in which he so long maintained an
exemplary and consistent daily life.

He illustrated the true type of a self-made man. He had no resources

Department of Necrology. 185

other than a strong will supported by inflexible integrity and a deter-
mination to overcome all reasonable obstacles. Having a desire for
the acquirement of knowledge, he struggled, under many physical
infirmities, during all his earlier years to acquire the elements of a
sound, practical education.

In the accomplishment of these laudable purposes he was eminently
successful. The high positions as an educator which he subsequently
held, and his marked success in the profession of medicine, attest in
the fullest degree inherent power to overcome almost insurmountable
difficulties.

Offices and 'Memberships. — He filled for several years the office of
coroner in the village where he so long resided. He also held mem-
berships in the Montgomery County Homoeopathic Medical Society,
in the New York State Homoeopathic Medical Society and in the
Medical Society of Northern New York, and, in 1870, was elected to
its presidency.

Resolutions of Respect. — The following resolutions were unami-
mously adopted at a meeting of the Montgomery County Homoeopathic
Medical Society, held April 13, 1886 :

" Whereas, The Homoeopathic Medical Society of Montgomery
County has learned with profound regret of the decease of a friend
and fellow-member, the late T. J. Pettit, M. D.; therefore

Resolved, That we receive with sorrow the news of his death, and
regret Jhat the medical profession in this vicinity has lost an able repre-
sentative, and this society one of its brightest ornaments and most
active supporters.

Resolved^ That we miss the genial manners that he brought to our
meetings and his active and intelligent participation in all the proceed-
ings of this society.

Resolved^ That, remembering his many social and Christian virtues,
our heartfelt sympathies are hereby extended to his family and friends
in their d<?ep bereavement, with the fervent hope that their affliction
may be lessened by the assurance that his memory will be cherished by
a community in which he was so universally beloved.

Resolved^ That a copy of these resolutions be presented to the family
of the. deceased, entered on the minutes of this society and published
in the county papers and homoeopathic medical journals."

The following resolutions were unanimously adopted at a meeting of
the Medical Society of Northern New York, October 27, 1886 :

Resolved) That we, the members of the Medical Society of Northern
New York, deeply mourn the loss by death of our esteemed associate,
the late Dr. T. J. Pettit, by which we are deprived the fellowship of a
revered and warm-hearted friend, and the public of an honored,
wise and influential citizen.

186 Department of Necrology.

Resolved, That his recognized integrity of character, his intense
desire to promote the advancement of medical science, his gentleness
and urbanity of manners, are worthy of imitation, and prompt us to
hold his name in respectful and enduring remembrance."

'CORNELIUS ORMES, M. D.,

JAMESTOWN, N. Y.

By Asa S. Couch, M. P.,

Dr. Cornelius Ormes was born at West Haven, Vermont, August,
4, 1807, of most excellent New England parentage. After receiving
a thorough academical education, he entered upon the study of med-
icine with Prof. Theodore Woodward, at that time the most noted
surgeon of the Eastern States, and received the degree of M. D. from
Castleton Medical College in 1832. After practicing for a time in
partnership with his preceptor, he removed to Chautauqua County,
N. Y., and opened an office in Panama, February 13, 1833.

In that early day, this portion of the county and the adjacent parts
of Pennsylvania were largely engaged in lumbering, and Dr. Ormes'
surgical experience obtained under Prof. Woodward peculiarly fitted
him for the exigencies constantly arising in that occupation. His ride
soon extended into Northern Pennsylvania, then almost a wilderness,
and his duties entailed upon him great hardships from the bad roads
which he was compelled to traverse and the severe exposure to which
he was frequently subjected. The success which attended his practice
however, soon gained for him a high reputation, which was increas-
ingly enhanced down to the time of his death.

As the country became more fully occupied and settled, the acci-
dents of pioneer life necessarily diminished and the doctor turned his
attention to new fields for the employment of his surgical ability. He
made a special study of ovarian diseases and soon established a national
reputation for the treatment and removal of ovarian tumors. During
his life he removed a large number of these and other new formations
and he continued to operate successfully for their extirpation up to
within a few months of his decease. In two of his ovariotomies, the
uterine appendages were all involved, the tumor in one being of the
colloid variety and weighing fifty-one pounds, while the uterus meas-
ured eleven inches in length, was extensively sphacelated from long
pressure, and its cavity wholly obliterated. The entire mass was sac-

*In No. 6 (June) Vol. VII. (1886) of the Physicians' and Surgeons' Investigator.

Department of Necrology. 187

cessfully removed and the patient still lives in the enjoyment of excel-
lent health.

In 1863 the doctor removed to Jamestown, and the better Held
greatly enlarged his already extensive practice.

In 1872 he was called to the chair of Obstetrics and Uterine Surgery
in the Detroit Homoeopathic College and discharged its duties with
marked advantage to the college and the cause of homoeopathy. Dr.
Ormes was first instigated to examine the new system by Dr. James
Birnstil, then of Westfield, N. T., afterward of Pittsfield, Mass.
After much study and a careful comparison of results from the old
and new systems, he gave in his adhesion to homoeopathy and has con-
sistently practiced it since 1848.

Dr. Ormes was, at the time of his death, and for many years had
been, President of the Homoeopathic Medical Society of Chautauqua
and Cattaraugus counties, was one of the physicians from Western
New York who assisted to re-organize the State Society in 1861, and
in which he was a permanent member at his decease ; was a member
of the new Homoeopathic Medical Society of Western New York
and a *' Senior " in the American Institute of Homoeopathy, he having
been elected a member in 1856. In all of these societies he occu-
pied a prominent place, and in all was the frequent recipient of posi-
tions of responsibility and honor. It will thus be seen that Dr. Ormes
was gathered u like a shock of corn fully ripe."

Few physicians have acquired as extensive and enviable a reputation,
and none will be more missed by the profession for those genial and
excellent qualities of manhood which shed an additional luster upon
the achievements of an intellectual life. He died at Jamestown, N. Y ,
20th of April, 1 886, aged 79 years.

JACOB S. PHILIP M. D.,

CATSKILL, N. Y. '

The subject of this sketch was born in Claverack, N. Y., on the
22d of November, 1824, where his youth was passed and his education
acquired. His medical education was received at the widely known
Vermont Medical College, located at Castleton, where so many of our
ablest physicians at the North acquired the principles and instruction
which answered them in such good stead in after life. Here he

188 * Department of Necrology.

received his medical degree on the 24th of November, 1847. He first
embarked in practice at Austerlitz, Columbia County, N. Y., where
he married Jane Elizabeth Brown, who still survives him. He
removed to Catskill, where he commenced practice in the early spring
following the advent of the cholera epidemic. Here, in the face of
strenuous opposition from the physicians of the old school, he bravely
made his way and as steadily gained in practice, which in the course
of time became extensive and remunerative, and at the time of his
death was the senior and leading physician of the place. For many
years he was the only homoeopathic physician of the vicinity. He was
a prominent member and president of the school board for many
years. He filled many positions of honor and trust ' through along
life of busy usefulness, and all his responsibilities and duties were dis-
charged with promptitude and fidelity. He was United States Exam-
ining Surgeon for Pensions, Health Officer, a member of the masonic
order and of the Dutch Reform Church, and President of the Colum-
bia County Medical Society. He was elected a member of the New
York State Homoeopathic Medical Society in 1881. He was the third
member of his family to adopt the medical profession, his brothers
John and James being also physicians.

His sickness began with a severe attack of acute rheumatism in
December, 1886, followed by metastasis to the heart. His condition
was alarming from the first, and death was imminent on several occa-
sions. During several of these attacks he was so fortunate as to have
the prompt attentions of his physicians, whose remedies were imme-
diately successful in relieving his condition. With the early spring
and its genial revivifying influence he was apparently better, but
undertaking to resume his labors too soon, his bodily infirmities were
too powerful for the determined will power with which he sought to
push forward in the routine of his work and business. He was again
stricken down, this time with paralysis and aphasia. Rallying a few
times, he at length succumbed, and on the 25th of April, 1887, death
came as a welcome relief to the terrible sufferings he had so long
endured. After examining showed that blood poisoning had super-
vened and that his case was beyond all reasonable hope of recovery.
His loss was deeply and generally lamented. He left a wide circle of
patients, and still wider of friends, to whom he had endeared himself
by his ready sympathy and kindly generosity. By his death the pro-
fession lost a skilful, worthy and honored practitioner, and the public

Department of Necrology. 189

at large a valued and valuable citizen. He left surviving him a widow
and two children to deplore his lose.

" Press on ! for it is godlike to unloose
The spirit and forget yourself in thought ;
Bending a pinion for the deeper sky,
And, in the very fetters of your flesh,
Mating with the pure essences of heaven !
Press on ! i for in the grave there is no work,
And no device.' Press on ! while yet you may."

ARTHUR P. HOLLETT, M. D.

HAVANA, N. Y.

Arthur P. Hollett was born on the 11th of April, 1847, at Geneva,
Ontario County, N. Y. Eichard T. Hollett, his father, was of Eng-
lish extraction, the family having emigrated to this country about the
year 1790 and first locating near Smyrna, in Delaware. His father
was a printer and publisher. His mother, Margaret C. Bruce, was born
in Scotland, and came to this country with her parents when she was
quite young. His father, eminent for his piety, was for a long period
an elder in the Second Presbyterian Church of Auburn, N. T. He
died at the comparatively early age of thirty-five, his (Arthur's) mother
surviving a few years later, when the subject of this sketch was left
alone at a tender age to struggle as best he might in the great battle of
life, not only for mastery, but even for the poor boon of existence.

u Thus at the flaming forge of life

Our fortunes must be wrought,
Thus on its sounding anvil shaped

Each burning deed and thought."

His early education was received under the care of his cousin, Prof.
W. W. Runyan, at the Sonora Academy in Steuben County. Before
the curriculum of his academic studies was completed the civil war
broke out. Animated by the patriotic fires which stirred the life
blood of so many gallant youths at the North, he aided in raising and
organizing a company, mostly composed of his fellow students, which,
under the command of one of his teachers, was consolidated with the
189th regiment New York volunteers, and mustered into the United
States service in September, 1864. Its record was carved in the fore-
front of battle

" Mid flame and smoke,

And shout, and groan, and sabre-stoke,"

190 * Depabtmbnt ojp Necrology.

at Hatcher's Run and Five-Forks, and Appomatox. His regiment
was one of the few New York commands which had the honor of
participating in the grand review at Washington at the close of the
war, after which it returned to Elmira and was mustered out on the
9th of June, 1865, the war being at an end.

With the close of his military career, with its hurry and worry,
and mortal risks, young Hollett, well seasoned to endurance and
application by the experiences, fatigues and hardships of camp life,
applied himself to the study of medicine in the office of the late Dr. H.
S. Benedict, of Corning, Steuben County, N". Y. When sufficiently
advanced, he matriculated at the Homoeopathic Medical College of
Pennsylvania at Philadelphia, from which institution he graduated in
March, 1869. Soon after receiving his degree he opened an office for
the practice of medicine and surgery at Havana, Schuyler County, N.
Y., where his pleasing, genial ways, his affable, courteous deportment
speedily won for him a host of friends and a large and lucrative prac-
tice. From this time forth his progress was upward and onward. He
was prominent in the councils of his school. He was largely instru-
mental in organizing the Schuyler County Homoeopathic Society, and
also of the Southern Tier Society. Having served as delegate to the
State Society in 1872, he was the following year nominated, and, in 1874,
elected to permanent membership therein. In 1879 and 1880 he served
as corresponding secretary, and in 1881 he was chosen recording sec-
retary of the State Society, and acted in that laborious capacity for
three consecutive years, discharging its onerous and exacting duties
with marked ability, fidelity and conspicuous energy.

" Finis Coronal opusP

Besides holding the office of secretary, Dr. Hollett was elected
third vice-president of the Society in 1884, and first vice-president
in 1885.

During the years of his membership in the State Society he was a
frequent and able contributor to its Transactions. He was elected a
member of the American Institute of Homoeopathy in 1874. Speak-
ing of his personal character and professional relations, one who knew
him intimately and well, indeed better probably than any other, says
of him : " The intellect of Dr. Hollett was very clear and discrimin-
ating. He sought to do everything he attempted with precision.
Modest and retiring in manner, gentle and sympathetic by nature, he
was loved best by those who knew him best. He was always ready to
go wherever there was sickness and suffering. He sacrificed his life

Department of Necrology. 191

in thus doing his duty. He was a careful, conscientious, Christian phy-
sician, beloved by his patients and respected by the profession. * * *
By Dr. Hollett's death homoeopathy has lost a staunch and enthusias-
tic supporter, suffering humanity a sympathetic and skillful friend,
the medical profession one of its brightest ornaments, and the com-
munity in which he lived one of its most useful citizens."

In his practice he had latterly made obstetrics a leading specialty,
in which it is stated that he never lost a case. While treating a fam-
ily suffering from diphtheria he contracted the disease himself, and
after an illness of only a few days died on the 29th of September,
1887, lamented by all. To add to the poignancy and affliction of his
surviving friends, his only child, a promising lad of thirteen years,
took the disease from his father and died on the 17th of October
following.

" Brevis a naturd nobis vita data est; at tnemoria bene redita vita
sempiternal

LORENZO M. KENYON, M. D.

BUFFALO, N. Y.

Dr. L. M. Kenyon, one of the most able and prominent homeo-
pathic physicians in the western part of the State, was born at Sheri-
dan, Chautauqua County, N. Y., March 18, 1821. He received a good
English education in the academy at Jamestown, N. Y., and immedi-
ately on leaving school in 1836, began the study of medicine with Dr.
Samuel Foote of that place. He afterwards studied with Dr. Carlton
Jones, of Westfield, and attended his first course of lectures at the Col-
lege of Physicians and Surgeons of Western New York, at Fairfield,
in the winter of 1838-39. His second course was at the Albany
Medical College in 1843-44. Soon afterward he began practice as an
allopathic physician in Warren, Pa., and later removed to Youngs-
town, Pa. After remaining therefor two years he went to Westfield,
N. Y., January 1, 1846.

Mrs. Kenyon being taken very sick at this place, and given up by
her husband and his partner, Dr. Carlton Jones, of Westfield, she was
restored to health by the treatment of Dr. W. G. Wolcott, a homoeop-
athic physician. In this way Dr. Kenyon's attention was called to
the superior advantages of the Hannemannian treatment, and on June

192 Depabtment of Necrology.

1, 1846, he began the practice of homoeopathy, which he followed for
over forty years, with pre-eminent success. While living at Westfield
he was postmaster of that place during the years 1854-55.

Removing to Buffalo, July 1, 1856, he entered into partnership with
Dr. N. H. Warner, at that time the most noted physician in Western
New York. This partnership continued until Dr. Warner's death, in
1860 For the past thirty-one years, with the exception or two years
spent in the South for his health, Dr. Kenyon has practiced in Buffalo.
His skill and success in his profession and his true, upright character
having been recognized by one of the largest practices ever secured
by a physician in that city.

In 1865 Dr. Kenyon was proposed as a permanent member of the
State Homoeopathic Medical Society, and elected as such the year
following. The same year he was made third vice-president of the
same, and in 1874 was chosen president of the Society. In 1883 he was
recommended for the honorary degree of M. D., conferred by the
Regents of the University of the State of New York, on those members
recommended by the Society.

In 1853 Dr. Kenyon joined the American Institute of Homoeop-
athy, and, on the expiration of the proper time, became one of the
senior members thereof. He has been president of the Erie County
Homoeopathic Medical Society, and was the first president of the
Homoeopathic Medical Society of Western New York, organized about
three years ago. He was also for many years Supreme Medical Exam-
iner of the Royal Templars of Temperance.

The doctor was a charter member of the Prospect Avenue Baptist
Church of Buffalo, and for the past twelve years, one of the revered
and honored deacons of the church.

For the past three years Dr. Kenyon had been suffering from angina
pectoris, but still continued his practice, only giving up obstetric and
night cases to his son, W. B. Kenyon, M. D. On the 8th of October,
1887, he was taken sick and suffered a great deal from then on,
especially the last two weeks of his life, till death came to his relief,
and on the 25th of November he passed away. His remains were
buried at Westfield, N. Y. He leaves a widow, and his son, Dr. W.
B. Kenyon, succeeds to his father's practice.

Beside the medical societies of which he was a member, Dr. Kenyon
belonged to the New Era Lodge of Odd Fellows. He was the first
master of the lodge of Ancient Landmarks, No. 441, F. & A. M. and
was a member of Keystone Chapter and of Hugh De Payne Com-

Depabtmbnt of Necrology. 193

inandery, Knights Templar. He had also attained the 89d degree of
the Scottish Bites Masonry.

Dr. Kenyon was a benevolent Christian physician, and was identified
with most of the public charities of Buffalo, and daily gave gratuitous
services to the poor. He was a man ever ready to lend a helping
hand to a brother practitioner, and most of the homoeopathic physicians
of the city, and the country round about, were wont to come to him
for consultation, and it is a common feeling among his professional
brethren that they have lost a good and safe counsellor as well as a true
and faithful friend.

WILLIAM HENRY RANDEL, M. D.,

ALBANY, N. Y.

Dr. William H. Randel was born at Albany, N. Y., August 28th,
1832. Under the supervision of his uncle, the late William R. Weeks,
D. D., he acquired an academical education at Newark, N. J. He
entered upon the study of medicine in the office of Doctors J. A. & H.
M. Paine, in Albany, and attended one course of medical lectures at
the Albany Medical College during the session of 1849-50. In the
spring of 1851 he was graduated from the medical department of the
University of the City of New York, and immediately afterwards began
the practice of homoeopathy in his native city. In addition to the skill
gained by study and the exercise of his profession, in order to fit him-
self still further for his duties the greater part of the year 1867 was
spent by Dr. Randel in a tour through the principal cities of Europe,
at which time he visited many hospitals in England and on the Conti-
nent, and pursued special courses of study in several of them.

He was present at the first meeting of the Albany County Homoe-
opathic Medical Society in 1861, when its organization was effected,
and in the year 1865 was elected its president. He was appointed a
delegate to the State Homoeopathic Medical Society in 1862, 1866,
1867, 1868, 1870, 1871 and 1873, at which last mentioned date he was
elected to permanent membership therein. In 1855 he beame a mem-
ber of the American Institute of Homoeopathy, and on account of a
membership therein of twenty-five years, became a senior member
thereof in 1880.

With the history and progress of the Albany City Dispensary and
Homoeopathic Hospital, Dr. Randel was closely identified, being present

t» ^

194 Department of Necrology.

at its organization in 1868. He was untiring in his labor to advance
its interest and enlarge its sphere of usefulness by obtaining donations
for its support, in his efforts in the direction of the care and treatment
of the patients therein, 'and in the use of such measures as were best
calculated to further its progress and establish it on a permanent and
abiding foundation. From 1868 to 1872 he was a member of its board
of trustees, since which the board has been made up solely of non-medi-
cal members. He was also a member of the medical staff and one of
the consulting physicians from its inception to the time of his death.

During the night of Mondaj 7 the 12th of December, 1887, Dr. Han-
del was attacked by paralysis from which he did not recover, dying on
the morning of Wednesday the 14th. He had been married twice, his
second wife and two children surviving him.

A special meeting of the County Homoeopathic Medical Society was
held on the evening of the 14th, at the office of Dr. Pratt, to take
appropriate action on the death of their colleague. The following
excerpts show the esteem in which he was held by his professional
brethren, and the reputation of the man. At that meeting Dr. Pratt
said " that he had known the deceased since 1854. Dr. Handel pos-
sessed a sanguine, ardent temperament, which led him to inspire his
patients with hope and confidence, even in the presence of the most
unpromising conditions. He fortunately combined many desirable
qualities of mind and heart which constitutes a successful physician, in
the exercise of which he attained eminence in his profession. No
physician in Albany attended more strictly to professional duties.
With the exception of a trip to Europe a few years ago, his absence
from the city has been a rare occurrence. Possessing a vigorous con-
stitution, he was seldom disabled by illness from attendance upon any
cases requiring his services. In the death of Dr. Randel this society,
of which he was a life-long and honored member, has met with a loss
we sincerely mourn."

Dr. Paine then spoke substantially as follows : " My acquaintance
with Dr. Randel extends over a period of more than forty years. We
were for several years schoolmates, and later he pursued the study of
medicine in my father's office. Dr. Handel's life illustrated the usual
characteristics of a self-made man. He acquired an academical educa-
tion by hard study at night. By dint of close application, at twenty-one
years of age he had qualified himself for attendance upon medical lec-
tures and had saved a sufficient sum to pay all necessary expenses.
After graduation he began practice at Albany, where, by persevering
effort, he succeeded in building up a large and lucrative practice.

Department of Necrology. 195

He was » earnest and persistent worker in the profession. His
time was wholly devoted to its duties. He seldom attended a place of
amusement or spent an hour in recreation or change. He never
allowed himself any rest. He devoted his earlier ypars to building up
a name as a faithful and reliable practitioner and in later life continued
the even tenor of this way unchanged. He possessed in an unusual
degree the power to inspire his patients with confidence. Their regard
for him as a true friend was so strong that their confidence in his
ability as a physician nsver flagged.' He was, to an eminent degree, a
prudent and successful practitioner; not because of great learning or
extensive acquaintance with medical literature, although he was a well-
read physician, but more particularly on account of familiarity with
practical therapeutic knowledge. His conservatism led him to attent-
ively study the practical uses of the more common methods, rather
then experiment with new and untried measures. In his medical
studies he discarded theoretical and visionary questions, and confined
his researches to those methods having a practical bearing upon the
cases he was called upon to treat. He was firm in his convictions, but
was not demonstrative. He was not a visionary enthusiast. Life was
a reality with him. He loved its duties, responsibilities, and even its
sacrifices, and cheerfully endeavored to conscientiously perform his
part with fidelity and zeal.

His genial and modest bearing, his kind and unassuming manner,
his steadiness of purpose, his untiring devotion to the welfare of his
patients, his family and the community in which he lived, are traits of
a well-rounded character to which his daily life gave practical illustra-
tion."

After alluding to the fact that this was the fourth time since the
society was organized that it had been called upon to take action rela-
ting to the death of one of its members, Dr. Gorham said : " The sud-
den removal from labor to rest of our lamented friend, Dr. Randel,
brings again vividly to memory the loss of our valued associate, Dr.
Delavan. Taken without warning, as they were, while in the midst of
life's activities, their good deeds constituting the essence of usefulness
to others, we sincerely mourn their death while we bow to the will of
the Infinite. I had not the pleasure of an intimate acquaintance with
Dr. Randel. When, however, I have met him I have been impressed
with his hearty good cheer, gentlemanly courtesy and earnest devotion
to professional work."

Eulogistic remarks were also made by Drs. Cox and Jones.

196 Department of Necrology.

The following resolutions of respect were then adopted by the
society :

Resolved, That the members of the Albany County Homoeopathic
Medical Society have learned with profound sorrow and regret of the
death of William H. Randel, M. D., a valued and honored member.

Resolved, That we hereby express our great sense of loss and grief
in the death of our colleague, and record the sincere regard in which
he was held by his medical associates.

Resolved, That by his sudden and untimely death we have lost a
genial and highly esteemed member, the profession a valued and faith-
ful worker and the people whom he served a friend, whose cheering
words and wise counsels will be long remembered.

Resolved, That in this deep affliction we extend our fullest sympa-
thies to his sorrow-stricken family.

Resolved, That a copy of these resolutions be spread upon the minntes
of this society and a copy be presented to the family of the deceased.

CHARLES G. CLARK, M. D.,

TROT, N. Y.

Charles G. Clark, M. D., one of the most prominent homoeopathists
of Troy, N. Y., was born in that city May 15, 1841. He was the oldest
son of Mr. and Mrs. Otis G. Clark. He was prepared for college at
Essex, Conn., and graduated from Union College in 1863, having dur-
ing his collegiate career, carried off the prize for the Greek oration.
He determined to pursue the profession of medicine, and graduated
from Ann Arbor, Mich., and afterwards continued his studies and
practice at Belle vue Hospital, New York. In 1866 he began practice
in Troy. The same year he married Miss L. Addie Johnson, of that
city, who, with one son, Charles J. Clark, a student at Rochester Uni-
versity, survives him. At the time of his death he had a large prac-
tice and was considered one of the city's most skilled, successful and
able physicians.

Dr. Clark was a Republican in his politics and presided as Chair-
man of local conventions on one or two occasions. He was elected
alderman in the third ward of his native city in 1880, and served one
term of two years. He was one of the first members of the Board
of Education, under the present law of Troy, being on the Board dur-
ing the years 1872, 1873 and 1874.

During the evening of December 13, 1887, friends called on him at
his residence, No. 84 Fourth street, where he visited with them, chat-

• I ■. "**»*L

Department of Necrology. 197

:.*3!

ing and laughing in a cheery manner. About ten o'clock they left the
house and soon afterward he was called to attend a patient at 83
Fourth street, nearly opposite his office. While there he became sud- , :•• ||
denly faint, but thinking his sickness but temporary, he prescribed for
himself and laid down on a lounge to rest. Instead of becoming bet-
ter he steadily grew worse, and Drs. Richard Bloss and R. B. Boute-
cue were sent for. All that medical skill could think of was done for
him, but after lingering until one o'clock on the morning of the 14th,
he expired. He was an athletic and robust man, apparently the pict-
ure of health. He had been complaining for some time, however, of a
rheumatic difficulty, but neither he nor his family considered it at all
dangerous. An autopsy wa» held, at which Drs. R. B. Bontecue, R. &
J. B. Bloss, William Seymour, W. Akin and J. W. Morris were pres*
ent, and the cause of his death was found to be congestion of the
lungs complicated with heart failure.

His funeral was attended from the Fifth Avenue Baptist Church, of
which he was a member, the Revs. H. O. Hiscock, C. P. Sheldon,
D. D., and J. H. Griffith, D. D., of Buffalo, officiating. The pall-
bearers were Drs. H. E. Fuller, M. W. Campbell, R. B. Bontecue,
M. H. Burton and Messrs. H. W. Gordinier and W. A. Sherman.
The attendance at the church was so large that it was impossible to
furnish seats for all and many stood in the aisles.

Dr. Clark was a gentleman of genial ways and of generous heart.
Of his success as a physician we have already spoken. Whatever the
public positions he held their duties were discharged with fidelity and
credit. The following resolutions were unanimously adopted at a
special meeting of the Rensselaer County Homoeopathic Society, held
Thursday, December 15th :

Resolved, That the members of the Rensselaer County Homoeo-
pathic Medical Society have learned with deepest sorrow and regret of
the sudden death of Dr. C. G. Clark, one of its most devoted and
earnest supporters.

Resolved, That we hereby signify the sense of the great loss which
we have sustained in the deatn of our esteemed colleague and give
expression to the high appreciation of his valued services to the medi-
cal profession, of wnich he was an honored and useful member, and
to the homoeopathic school, of which he was an able and distinguished
representative.

Resolved, That in this afflictive dispensation we have been deprived
of a member whose quick perceptions, sound and reliable suggestions
and rich experience rendered him a safe and valued associate ; and the
sick and suffering a friend and counselor whose benignant presence
will not be readily replaced or supplied.

198 Department of Necrology.

Resolved, That while his sterling good sense, his manly and generous
impulses, his affable, genial and social qualities of heart and mind
endeared him to the public, he was also held in high esteem by his
medical associates on account of his careful regard for the courtesies
and amenities of professional fellowship.

Resolved, That a copy of these resolutions be entered on the records
of this society, transmitted to the family of the deceased and pub-
lished in the daily papers.

Hiram E. Fuller, M. D., Secretary.

■I

Biographical Sketch of

Horace marshfield Paine, a. m. m. d.

Dr. Horace M. Paine, of Albany, N. Y., was born at Paris, Oneida
County, N. Y., November 19, 1827. He is the eldest son of the late
Dr. John A. Paine, and is the only brother of Professor John A. Paine,
of Tarrytown, N. Y.

Dr. Paine received an academical education at Newark, N. J., under
the supervision of his uncle, the late William R. Weeks, D. D., as his
father had thirty years previously; pursued the study of medicine
under the direction of his father, and was graduated from the medical
department of the University of the City of New York, March 11,
1859. He received the honorary degree of Master of Arts from Ham-
ilton College in June, 1860, and also the honorary degree of Doctor of
Medicine, on recommendation of the Homoeopathic Medical Society of
the State of New York, in July, 1881.

He began practice in Albany in the spring of 1849 ; remained until
August, 1855, when he removed to Clinton, Oneida County, N. Y.,
where he resided ten years, returning in 1865 to Albany, his present
(1888) residence, where he is engaged in consultation and general
practice, giving attention more particularly to the treatment of non-
surgical uterine diseases. Prior to the year 1849, the accessions to the
ranks of homoeopathic practitioners were from among those who had
been previously engaged for several years in old-school practice. Dr.
Paine was the first young physician who began the practice of homoe-
opathy at Albany immediately after graduation.

Dr. Paine adopted the homoeopathic system of practice at the begin-
ning of his professional life, and adheres to it chiefly. By the term of
u homoeopathic system of practice" he intends to embrace only the
principle of similars. He rejects the doctrine of the minimum dose,
using the words small dose preferably, as less misleading and less
likely to prove harmful to correct homoeopathic principles. He believes
Hahnemann's theories to be visionary and unphilosopical regarding the
origin of chronic diseases and the dynamization (spiritualizing) of drugs,
whereby a largely increased curative force is supposed to be developed
by a process of agitation long after the medicinal substance in a mate-

* v

200 Biographical Sketch.

rial form has ceased to exist. He believes that the only curative force
thus imparted (if any really exist), is merely a development of well-
known magnetic or psychological influences which are being constantly
and successfully applied, with even more prompt and remarkable
results, than are claimed for the use of dynamized homoeopathic
remedies.

Having joined the homoeopathic school while still in its infancy he
shared with his associates the ostracism and professional seclusion mani-
fested by old-school opponents. The bitterness of feeling on the part
of the old-school, which at that time was almost universal, incited
many of the more prominent homoeopathists in New York State to
unite in instituting measures for obtaining, in behalf of themselves and
their colleagues, such legal recognition as would give them an honorable
and reputable standing before the public. After many trials, repeated
failures and years of patient, persistent effort, those who early entered
upon the work of securing an equal legal status with that of the old-
school were finally gratified by the erection of a distinct school of
medicine, and as such, recognized by the laws of the State.

The establishment of this distinct school, on account of the compari-
son before the public of the two rival systems continually being made,
has largely contributed to the marked change in the old-school system
of treatment, and has forced its practitioners to observe, more clearly
than ever before, the exact natural relationship between diseases and rem-
edies, and hence to become more accurate and more successful physicians.

Dr. Paine early became an active participant in these reformatory
measures. To such an extent is this true that a full description of his
efforts in connection with the* polemics of homoeopathy would consti-
tute a tolerably complete record of the homoeopathic school during
twenty years of its history in this State.

On his retirement from the secretaryship of the New York State
Homoeopathic Medical Society, suitable testimonials were presented
him, setting forth the character and results of his efforts for the per-
manent establishment of the homoeopathic school on a legal and
political basis equal to that of the allopathic. A full report of the pro-
ceedings had in connection with the presentation of these testimonials
is published in the tenth volume of the Transactions of the Homoe-
opathic Medical Society of the State of New York. They are not only
complimentary to those who were the active participants in the work,
but also constitute a chapter in the early experience of the homoeop-
athic school of special significance and interest.

Biographical Sketch. 201

Through these persistent and well directed efforts, and those of
equally zealous and successful colleagues in other states, our present
honorable position has been attained, and the prestige and influence of
the homoeopathic school, which represents advanced, sound and dis-
tinctive principles, has been finally secured.

Soon after the legal separation of the rivals, it became manifest that
the members of the old-school were endeavoring to convey the impres-
sion that homoeopathists were not educated in any except their own sys-
tem, and on that account were not competent or trustworthy physicians.
This impression gained credence in some localities to such an extent
that the sectarian name homceapathist came to have a restricted and
illiberal meaning, and to denote one who, by education and practice,
was a believer in and practitioner of a single dogma, and not & physi-
cian in the broadest and most liberal use of the term.

In order to assist in correcting this false impression, for a number of
years prior to 1880, Dr. Paine advocated the disuse of the sectarian
name, and endeavored to promote all measures having, for their object
the union of all qualified medical men on a liberal foundation without
regard to therapeutic belief. During that year, however, the Homoe-
opathic Medical Society of the State pf New York adopted a declara-
tion stating substantially that while homoeopathists believed in and
endeavored to apply the principle of similars, and considered it pref-
erable to any other method extant in a large percentage of cases, they
admitted the occasional curative value of remedies other than homoe-
opathic, and held themselves ready to use any and all measures
required by the exigencies of any case under treatment.

Since the formal adoption of the foregoing declaration, Dr. Paine
has not advocated a disuse of the distinctive name, on the ground that,
being properly defined and qualified, its use could not reasonably there-
after be made applicable in an objectional sense, its reference being
thereby limited to a rational system of treatment rather than a class of
physicians ; in fact, in order to intelligently distinguish between
opposing therapeutic systems, a specific name seems indispensable.

In the department of drug proving, as required by the homoeopathic
system, Dr. Paine has contributed several thorough and serviceable
trials, notably provings of Rumex crispus (yellow dock), Aesculus
hippocastanum (horse-chestnut), and Cimicifuga (actea) Eacemosa
(black cohosh). He has also invented new forms of syringes for apply-
ing soft cerates in intra-uterine treatment, also several new forms of
pessaries and uterine supporters ; also new and improved apparatus for

202 BlOGBAPHIOAL SKETCH.

the prolonged application of hot crater in the treatment of uterine and
pelvic diseases ; he also demonstrated the utility of Carbonate and
Iodide of Lime in the treatment of scirrhus of the breast and uterine
fibroids.

He has contributed upwards of fifty articles for publication in cur-
rent medical journals and in the Transactions of the Horuceopnthie
Medical Society of the State of New York. The more important
subjects treated in the3e essays may be classed under the following
heads : Rare and Important Clinical Cases ; Drug Proving ; Hygiene ;
Medical Education ; Registration of Prevailing Diseases ; Superiority
of Homoeopathic Treatment ; Danger to Homoeopathy from Erroneous
and Unphilosophical Theories; Freedom of Medical Opinion and
Action ; Medical Legislation ; and the Legal Status, Organization and
Progress of Homoeopathy.

The more important offices and appointments held by Dr. Paine are
the following :

Became a member of the American Institute of Homoeopathy in
1850, and a senior member thereof in 1875, its provisional Secretary
one year in 1867, and Secretary of the Association of Seniors in 1884.

He was present and became a member of the Homoeopathic Medi-
cal Society of the State of New York at its organization in 1850,
became a permanent member in 1864, was elected its Secretary in
1S59, and held that office, with the exception of one year, until 1873,
and was elected to the presidency of the society in 1887.

He was present and became a member of the Oneida County
Homoeopathic Medical Society at its organization in 1857, and retained
membership therein until 1865, was elected its Secretary in 1858, and
held the office seven years.

Became a member of the Albany County Homoeopathic Medical
Society in 1865, its Secretary from 1865 to 1870, and its President in

1874 and 1887.

Became a member of the Medical Society of Northern New York
in 1865, was elected its President in 1870, and its Secretary in 1880,
serving five years.

Was appointed Medical Director of the Atlantic Mutual Life Insur-
ance Company in 1866, at its organization, and held the office eleven
years, during the whole period of its existence.

Was elected to membership in the Board of Trustees of the Albany
City Homoeopathic Dispensary at its organization in 1868, and of the

Biookaphioal Sketch. 203

Homoeopathic Hospital in 1872 ; also a member of the Medical Staff
and Executive Committee since 1868.

Was appointed in 1871 by the Homoeopathic Medical Society of the
State of New York, a member of a special committee, in conjunction
with similar committees of other State Homoeopathic Medical Socie-
ties to visit President U. S. Grant at Washington, for the purpose of
protesting against the unjust action of Dr. H. Van Aernain, Commis-
sioner of Pensions, for having attempted the establishment of sectari-
anism in medicine by the removal of homoeopathic pension surgeons.
The reason given by Dr. Van Aernam being that they belonged to a
school of medicine which " was n-ot recognized by the government"
(Dr. Van Aernam was dismissed a few weeks thereafter).

Became a member of the first State Board of Medical Examiners
appointed by the Regents of the University of the State of New York
at its organization in 1872, and still (1888) retains membership therein y
was elected its Secretary in 1873, and held the office four years.

Became a member of the Board of Trustees of the New York State
Homoeopathic Asylum for the Insane, at Middletown, Orange County,
in 1872, and remained in office seven years.

Was appointed associate editor of The Medical Union, a monthly
medical journal published in New York *city, in 1873, and held the
appointment one year.

Became physician to the Albany House of Shelter, a reformatory
institution, in 1877, and still (1888) holds the position.

He has been elected to honorary membership in the State Medical
Societies of California, Connecticut, Illinois, Massachusetts and Penn-
sylvania; the Central Homoeopathic Medical Society of Germany;
the Imperial Homoeopathic Medical Society of St. Petersburg, Russia,
and several other institutions and county medical societies.

Dr. Paine' s ancestors are traced back through nine generations, the
original members having emigrated from England in 1651 or 52, and
settled first at Salem, afterward at Dedham, Mass., and finally at South-
old, Long Island.

He married Charlotte Mann, daughter of Salmon Mann, Esq., in
1852. He has three sons and one daughter. Residence (1888) Albany,
N. Y.

Nathaniel Emmons Paine, A. M., M. D., Hamilton College, class of
1879, Albany Medical College 1875, Superintendent of the Westboro
Insane Hospital, Westboro, Mass.

204 Biographical Sketch. ,

Howard Simmons Paine, A. M., M. D., Hamilton College, class of
1878, Albany Medical College, 1881. Engaged in general practice at
Albany, K Y.

Clarence Mann Paine, A. M., M. D., Hamilton College, class of
1884, Albany Medical College, 1887. Engaged in general practice at
Albany, N. Y.

Emily Florence Paine was graduated from Mount Holyoke Semi-
nary, class of 1886.

CONSTITUTION AND BY-LAWS .

OF THE

HOMCEOPATHIC MEDICAL SOCIETY

OF THE

State of New York.

CONSTITUTION.

Article I.

Name and Object. — This association shall be known as the Homoe-
opathic Medical Society of the State of New York, and its object shall
be the advancement of medical science.

Article II.

Laws of the State Deemed a Part of the Constitution. — -The laws of
the State of New York, regulating the practice of medicine and surgery
shall be deemed a part of this constitution.

Article III.

Officers. — When and How to be Elected. — The officers of this
Society shall be a president, three vice-presidents, secretary and treas-
urer ; all of whom shall be elected by ballot at an annual meeting.

Election of Censors. — The Society shall also, at an annual meeting,
elect twelve censors, any three of whom shall constitute a quorum.

Majority Vote Necessary to a Choice and Term of Office. — At all
elections of officers the votes of a majority of the members present shall
be necessary to a choice ; their term of office shall commence at the
adjournment of the meeting at which they were elected, and shall con-
tinue for one year, or until the close of the annual meeting next suc-
ceeding the one at which they were elected, and until others are chosen
in their places.

Article IV.

Duties of Officers. — The duties of the officers shall be such as are
prescribed by the laws of the State, and in addition thereto, such as
may be from time to time designated by the by-laws.

206 Constitution and Bp~Laws.

Article V.

How Constituted. — The Society shall be composed of delegates from
each county homoeopathic medical society and horpoeopathic medical
college in this State, and such other members as may be designated in
the by-laws.

Article VI.

Annual Meeting. — The annual meeting of the Society shall be held
in the city of Albany, commencing on the second Tuesday in February
of each year.

Article VII.

Quorum — At any meeting of the Society seven members shall con-
stitute a quorum.

Article VIII.

Seal. — The Society may have a common seal with a suitable device
and inscription.

Article IX.

Amendments. — This constitution may be altered or amended by a
two-thirds vote of the members present, provided that notice of such
alteration or amendment shall have been given in writing at the pre-
vious annual meeting.

BY-LAWS.

Section 1.

Duties of the President. — The president shall preside at the meet-
ings of the Society, preserve order therein, put all questions, announce
the decisions, appoint committees not otherwise ordered ; receive and
pay over to the treasurer the sum of ten dollars for each diploma
granted by the Society ; direct the secretary to call extra meetings on
the written request of any seven members explaining the reason for
such action ; deliver an address at the annual or semi-annual meeting,
or procure a substitute, and perform such other duties pertaining to
his office as may be required of him by the Society.

Section 2.

Duties of the Vice-Presidents. — It shall be the duty of the vice-presi-
dents, in the order of their election, to perform, in the absence of the
president, the duties of that officer.

Constitution and By-Laws. 207

Section 3.

Duties of the Secretary. — It shall be the duty of the secretary to
provide a book in which he shall make an entry of all resolutions and
proceedings which may be had from time to time ; also the name of
each and every member of said Society, and the time of his admission ;
preserve all documents belonging to the Society ; divide the delegates
into four classes in compliance with section nine of these by-laws ; give
notice of all meetings and deliver to his successor in office all books
and papers belonging to the Society.

Section 4.

Correspondence. — It shall be the duty of the secretary to receive and
lay before the Society all communications addressed to it, and gener-
ally to conduct the correspondence of the Society ; notifying bureaux
and committees of their appointment ; notify the secretaries of the
respective county societies whenever there are vacancies in the list of
delegates, and perform such other duties pertaining to his office as, by
vote of the Society, may devolve upon him.

Section 5.

Duties of the Treasurer. — The treasurer shall receive and be
accountable for all moneys belonging to the Society, pay out, on the
warrant of the president, such sums as may be agreed upon at the
annual meeting, and report in writing at each annual meeting.

Section 6.

Duties of Censors. — It shall be the duty of the censors to examine
carefully the credentials of all applicants for membership that may be
referred to them, and determine whether the applicant has proper quali-
fications for permanent membership in the Society, the votes of a
majority of the members of the board of censors present at an annual
or semi-annual meeting being a prerequisite to the election of a can-
didate.

Section 7.

Executive Board. — The president, vice-presidents, secretary and
treasurer shall constitute the executive board, whose duty shall be to
make arrangements for the meeting of the Society, arrange the busi-
ness of the sessions, attend to matters of business not otherwise specially
provided for, and perform such other duties as .may, by vote of the
Society, devolve upon it. This board shall also constitute the advisory
committee of publication, to whom shall be referred all papers, the
publication of which is deemed by the secretary and chiefs of bureaux
of doubtful expediency.

208 Constitution and By-Laws.

Section 8. — Bureaux and Committees.

Materia Medica. — There shall be a bureau of materia medica and
provingg, which shall obtain facts relating to the materia medica and
institute and collect and arrange provings of the drugs. There shall
be, in connection with this bureau, a department of pharmacy.

Clinical Medicine — There shall be a bureau of clinical medicine,
which shall collect facts relating to clinical medicine generally, and spec-
ially to any epidemic or endemic diseases which may exist in the State.

Obstetrics. — There shall be a bureau of obstetrics, which shall collect
and report to the Society facts and observations on subjects pertaining
thereto.

Surgery. — There shall be a bureau of surgery, which shall report all
improvements in surgery.

Mental and Nervous Diseases. — There shall be a bureau of mental
and nervous diseases, which shall collect and report facts relating espec-
ially to 6uch diseases.

Gynaecology. — There shall be a bureau of gynaecology, which shall
report to the Society all items of importance in that department of
medical science.

Pcedology. — There shall be a bureau of paedology, which shall report
facts and deductions in treatment of diseases of children.

Ophthalmology. — There shall be a bureau of opthalmology, which
shall report all improvements in that branch of science

Histology. — There shall be a bureau of histology, which shall report
facts in histology.

Climatology. — There shall be a bureau of climatology, which shall
report on the climate of different localities, and the influence of climate
on health and disease.

Vital Statistics. — There shall be a bureau of vital statistics, which
shall report all items of comparative mortality and such other facts as
pertain to the subject.

Medical Education. — There shall be a committee on medical educa-
tion, which shall report all progress in the elevation of the standard of
education.

Societies and Institutions. — There shall be a committee of societies
and institutions, which shall keep a register of all homoeopathic physi-
cians in the State, prepare a list of socities and organizations, and col-
lect statistics regarding the status and progress of homoeopathy.
There shall be in connection with this committee a department of
necrologv.

Constitution and By-Laws. 209

Appointment. — Each of these bureaux and committees shall consist

of as many members as the president shall see fit to appoint — not less

than three — who, with the exception of the chairman, shall be

' appointed annually by the president, with the advice of the other

members of the executive board.

Chairmen of similar bureaux in county societies shall be, eu>-ojficio,
corresponding members of these bureaux.

Finance Committee. — There shall be a finance committee, which
shall consist of the treasurer of the Society, ex-ojficio, and two mem-
bers, to be appointed annually by the president, the same as members
of other committees are appointed. No officer or committee of the
Society shall be authorized to expend any money of the Society, or
incur any debt in the name of the Society, without the consent of a
majority of this committee. No resolution, calling for the expending
of any money, shall be presented to the Society for its approval, till it
has received the approval of a majority of this committee.

Section 9. — Membership.

Delegates from County Societies. — Each county homoeopathic medi-
eal society in this State is entitled to elect as many delegates to this
Society as there are members of assembly to their respective counties.

Delegates from Institutions. — Each homoeopathic medical college,
hospital, asylum, dispensary, board of medical examiners, or other cor-
porate homoeopathic institution or association, shall be entitled to single
delegate representation in this Society, upon payment of the same dues
as other delegates.

Classification of Delegates. — Delegates to this Society shall be
divided into four classes, one of which shall go out of office annually ;
and it is hereby made the duty of the secretary to so classify them as
to keep the number as nearly equal as possible.

Permanent Members. — Any legally qualified physician may be
elected a member of this Society upon written recommendation of
three permanent members. Nominations shall be received at an annual
or semi-annual meeting, and being referred to the censors, shall come
up at an annual meeting. Those physicians recommended by the
board of censors shall be balloted for, and all who receive a majority
of the votes of those present shall be declared elected. When the
application is presented, the candidate shall sign the following state-
ment : I request membership in the Homoeopathic Medical Society of
the State of New York, and I agree, if elected, to pay my annual dues

to the Society. I hereby acknowledge that I believe in the law
Similia Similibus (Jurantur.

210 Constitution and By-Laws.

Privileges. — Persons so elected shall be entitled to all the privileges
of membership.

Honorary Members. — The Society may elect honorary members,
non-resident of this State, not to exceed six in number in any one year,
the names of such persons having been presented at least one year pre-
vious to their election. Before election reasons shall be stated to the
Society for conferring the honor.

Privileges. — Honorary members shall not be entitled to vote at the
meetings of the Society, or be subject to taxation.

Senior Members. — Any permanent member over sixty-five years of
age may be elected a senior member of this Society at any annual
meeting, provided that at the time of said election he or she shall have
been a permanent member for the previous twenty years, and is at the
time of his or her election in good standing in the Society.

Privileges. — Persons so elected shall be entitled to all the privileges
of membership, and shall be exempt from taxation and dues.

Regmttf Degree. — The Society may annually recommend the names
of four persons to the Regents of the University for the honorary
degree of doctor of medicine, provided that the person so recom-
mended shall possess good moral and professional standing, shall have
attained the age of forty-five years, and shall have received the votes
of not less than two-thirds of the members present at any annual meet-
ing. The mode of nomination shall be as follows : Names shall be
presented in open nomination, and be referred to a committee appointed
for the purpose, which shall report after the election of officers ; the
number to be voted for at one ballot shall not exceed four, and
the names of those only who shall have received the .votes of two-
thirds of the members present shall be presented.

Section 10.

Dues. — The dues' from each permanent member shall be five dollars
for the first year, which shall include the certificate of membership,
and three dollars for each subsequent year. From each county society
there shall be due three dollars for each delegate to which the society
is entitled, and from each institution which sends a delegate.

All dues shall be declared due, and payment of the same to the treas-
urer of the society required, within thirty days succeeding the annual
meeting.

Any members in arrears shall not be entitled to the privileges of
membership.

Any member five years in arrears shall be dropped from the roll and
not be eligible for re-election until all arrearages are paid.

Constitution and By-Laws. 211

Each permanent member not in arrears for does shall be furnished
with one copy of the Transactions of the Society without further cost,
and each county society with as many copies as it pays " fees " for
delegates.

Section 11.

Duties of Secretaries of County Societies. — The secretary of each
county homoeopathic medical society in this State is requested to fur-
nish the secretary of this Society, on or before the first day of January
of each year, a report consisting of : —

1. A list of officers and members of his county society with their
addresses in full.

2. Biographical notices of any who have died during the previous
year.

3. The time of holding annual and regular meetings, together with
a list of all medical committees and a complete copy of the proceed-
ings of each meeting.

4. A copy of all reports of general interest, also copies of addresses
and communications on subjects relating to medical science.

Section 12.

Nominations. — At each annual meeting the nomination of the offi-
cers of the society, chairman of bureaux, delegates to other societies
and honorary members shall be made openly, except when referred to
a committee on nominations to be appointed for that purpose. With
each nomination for honorary membership the reason for conferring
the honor shall be stated to the Society.

Section 13.

Communications ; their publication. — Communications read before
the Society become its property to be deposited in its archieves ; but no
paper shall be published as a part of the Transactions without the
approval of a majority of the committee on publication, unless the
same be ordered by a vote of the Society.

Section 14.

Order of Business. — At the meetings of the Society the following
shall be the regular order of business :
First day. 1. Communication from the president.

2. Reading of the minutes of the last meeting.

3. Report of the committee on credentials.

4. Election of officers, chairman of bureaux, delegates to other
societies, permanent and honorary members previously nominated.

212 Constitution and By-Laws.

5. Report of the treasurer, and the auditing of his accounts.

No other business 6hall be considered by the Society until the fore-
going items are disposed of, when subjects of a miscellaneous character
may be entered upon.

6. Report of medical committees.

7. Presentation of reports and communications on medical and sur-
gical subjects.

Section 15.

Amendments. — These by-laws may be altered or amended at any
regular meeting by the vote of two-thirds of the members present.

Deceased Permanent Members.

213

3n ADemorf am*

DECEASED PERMANENT MEMBERS.

Yew of
Election.

Name.

86.'> P. W. Gray,

866 W. G. Wolcott,

865 E. A. Potter,

868 M. M. Matthews, -

869 A. Cooke Hull,- -

863 H. S. Benedict,

867 Edgat B. Cole, -

871 A Win Shattuck, -

866 John Sarles,
M6 Albert Wright,

869 E. P. K. Smith, -

870 Henry E. Morrill, -

872 Nathan Spencer, -
866 Benjamin F. Bowers,
872 Win. Baxter, A. M., -

872 James Cromwell,

864 S. B. Barlow,

866 Lyman Clary, -
870 Hylon Doty,
875 Geo. F. Hurd,

865 Carroll Dunham, A. M.,

873 Wm. J. Bryan, -

874 Henry Sales,
864 Daniel D. Smith,

867 Franklin F. Hunt, -
863 Erastus A. Munger,

869 Stephen D. Hand, -

870 L. B. Waldo, A. M., -

871 H. V. Miller, A. M.,
873 J. M. Cadmus, -

868 H. F. Adams,
868 Alfred H. Beers,
879 E. B. Squires, -
864, William Wright,

Afire. Date of Death.

59, Dec. 18, 1865,
50, Sept. 7, 1866,
61, July 29, 1867,
58, Nov. 23, 1867,

50, July 3, 1868,
46, Oct. 18, 1869,
45, Nov. 10, 1871,
52, Aug.13, 1872,

Nov. 7, 1873,
70, Dec. 1874,

57, Dec. 27, 1874,
61, Mar. 6, 1874,
65, Dec. 17, 1874,
79, Feb. 1875,

70, July 3, 1875,

64, Dec. 7, 1875,
78, Feb. 27, 1876,
74, June 1, 1876,

58, May 5, 1876,
26, Sep. 29, 1876,
.49, Feb. 18, 1877,
39, July 13, 1877,

65, Mar. 8, 1877,

71, Mar. 7, 1878,
68, Oct. 20, 1878,

66, Nov. 4,1879,

72, Mar. 10, 1879,
•64, July 9,1879,

51, Nov. 26, 1879,
45, May 10,1879,

41, Jan. 12, 1869,
29, May 7, 1879,
74, Sep. 23, 1880,

Residence.

Elmira.

Whitehall.

Oswego.

Rochester.

Brooklyn.

Corning.

Waterford.

Buffalo.

Brooklyn.

Auburn.

Brooklyn.

W. Windfield.

New York.

Wappinger's Falls.

Lake George.

New York.

Syracuse.

Wellsville.

Rochester.

Irvington.

Corning.

Elmira.

Brooklyn.

New York.

Waterville.

Binghamton.

West Troy.

Syracuse.

Waverly.

Canastota.

Buffalo.

Syracuse.

Brooklyn,

214

Deceased Permanent Members.

Y«rtf

Station. Name.

1866 Marcellii8 M. Gardner, -

1867 A. C. Burke, A. M., m -
1867 Garret D. Crispell, -
1874 Benjamin Lansing,
1880 Warren Freeman, -
1863 Benjamin F. Cornell, -

1865 E. T. Kichardson, -
1872 W. B. Stebbins, -

1866 Jno. F. Gray, LL. D.,

1874 Albert E. Sumner, A. M.
1880 Win. Scherzer,

1 867 Augustus Pool, -

1868 B. B Schenck,

1868 Harmon Swits, -

1869 C H. Carpenter, -

1872 George W. Peer,

1878 C. E. Blumenthal, LL D.

1880 Wm. H. Van Derzee, -

1863 Abijah P. Cook, -

1879 L. W. Flagg,

1870 F. W. Ingalls,

1871 John Savage Delavan -
1877 Augustus C. Hoxsie,
1882 Theophilus W. Kead,
1868 Benjamin F. Joslin,

1864 David F. Bishop,
1871 Thos. J. Pettit,
1871 Cornelius Ormes,

1877 C. M. Lawrence,* -

1878 Carl Th. Liebold,*
1863 Titus L. Brown,* -

1881 Jacob S. Philip, -

1875 Arthur P. Hollett, -
1866 L. M. Kenyon, -

1873 Wm. Henry Eandell.
1870 Chas> G. dark, -

Age. Date of Death.

49, July 31, 1880,

62, Apr. 15, 1880,

75, Dec. 15, 1880,
Sep. 21, 1880,

65, April 5, 1880,

76, May 12, 1881,
67, Aug. 14, 1881,
74, Nov 4, 1881,

. 78, June, 6, 1882,

, 42, Aug.31, 1882,

57, Feb. 21, 1882,

65, Aug. 9, 1883,

74, Mar. 22, 1883,

64, June 25, 1883,
■ 58, Sep. 23, 1883,

63, Jan. 12, 1883,
, 69, Oct. 11, 1883,

26, Aug. 29, 1883,

- 76, Sep. 23, 1884,

1885,

Feb. 15, 1885,
44, Aug. 7, 1885,

- 47, May 23, 1885,

65, Nov. 17, 1885,

- 55, Apr. 18, 1885,
57, Apr 24, 1885,

- 69, Mar. 3, 1886,
79, Apr. 20, 1886,

Sep. 30, 1886,

Nov. 30, 1886,

Aug. 17, 1887,

63, Apr. 25, 1887,

- 40, Sep. 29, 1887,

66, STov. 25, 1887,

- 55, Dec. 14, 1887,
46, Dec. 14, 1887,

Residence.

Utica.

Brooklyn.

Kingston.

Rhinebeck.

New York.

Fort Edwards. *

Brooklyn.

Little Falls.

New York.

Brooklyn.

New York.

Oswego.

Plain ville.

Schenectady.

Troy.

Rochester.

New York.

Albany.

Hudson.

Yonkers.

Kingston.

Albany,

Buffalo.

Big Flats.

Montclair. N. J.

Lockport.

Fort Plain.

Jamestown.

Port Jervis.

New York.

Binghamton.

Catskill.

Havana.

Buffalo.

Albany.

Troy.

♦Biographical sketches of Drs. Lawrence, Liebold and Brown will appear in next Volume of
Transactions.

LIST OF

OFFICERS.

Honorary, Senior, Permanent

DELEGATE MEMBERS.

216

List of Officers.

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List of Officers.

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218 Honoraby Members.

HONOBABY MEXBEBS.

1864.

Constantine Hering, M. D., Philadelphia, Penn.

I.T. Talbot, M. D., Boston, Mass.

E. C. Witherill, M. D., Cincinnati, Ohio.

1865.

*Gaylord D. Beebe, M. D., Chicago, 111,
Edwin M. Hale, M. D., Chicago, 111.
*A. H. Oakley, M. D., Providence, E. I.
John C. Sanders, M. D., Cleveland, Ohio.
David Wilson, M. D., London, England.

1866.

*Elial T. Foote, M. D., New Haven, Conn.
*Samuel Gregg, M. D., Boston, Mass.
Charles T. Harris, M. D., Syracuse, N. T.
*Wm. E. Payne, M. D., Bath, Me.
Francis Sims, M. D., Philadelphia, Penn.
David S. Smith, M. D., Chicago, 111.

1867.

*Walter Williamson, M. D., Philadelphia, Penn.
*Ira Barrows, M. D., Providence, R. I.
Robert E. Dudgeon, M. D., London, England.
*E. C. Franklin, M. D., St. Louis, Mo.
Wm. L. Jackson, M. D., Boston, Mass.
Alvin E. Small, M. D., Chicago, 111.

1868.

Charles Cropper, M. D., Lebanon, Ohio.
Charles Cullis, M. D., Boston, Mass.

Edwin R. Heath, M. D., , Kansas.

William H. Holcomb, M. D., New Orleans, La.
Bushrod W. James, M. D., Philadelphia, Penn.

1869.

*William Bayes, M. D., London, England.
T. C. Duncan, M. D., Chicago, 111.
Win. Henderson, M. D., Edinburgh, Scotland.
John C. Morgan, M. D., Philadelphia, Penn.

Honorajry Members. 219

1870.

John Drummond, M. D., Manchester, England.
John J. Drysdale, M. D., Liverpool, England.
John J. Edie, M. D., Leavenworth, Kansas.
*Dr. v Grauvogl, Munich, Bavaria.
H. R. Madden, M. D., London, England.
D. G. Woodvine, M. D., Boston, Mass.

1871.

C. Hempel, M. D., St. Petersburg, Russia.

B. Hirshel, M. D., Dresden, Saxony.

Alfred C. Pope, M. D., Lee, England.

Mathias Roth, M. D., London, England.

*Robert J. McClatchey, M. D., Philadelphia, Penn.

1872.

0. G. McKnight, M. D., Providence, R. I.
*W. W. Rodman, M. D., New Haven, Conn.

1873.

*E. H. Ruddock, M. D., London, England.
L. de V. Wilder, M. D., Hartford, Conn.

F. B. Mandeville, M. D., Newark, N. J.
Samuel Worcester, M. D., Salern, Mass.

1874.

*Leverett Bishop, M. D., Sauquoit, N. Y.
R. Ludlam, M. D., Chicago,' 111.

1875.

G. E. E. Sparhawk, M. D., Burlington, Vt.

1876.

*G. W. Swazy, M. D., Springfield, Mass.
*J. H. Pulte, M. D., Cincinnati, Ohio.

1878.
Thomas Skinner, M. D., London, England.

1879.

E. G. Cook, M. D., Chicago, 111.

H. A. Houghton, M. D., Charlestown, Mass.

220 Honoeaky Members.

1880.

E. A. Guilbert, M. D., Dubuque, Iowa.

H. N. Guernsey, M. D., Philadelphia, Penn.

1881,

J. P. Dake, M. D., Nashville, Tenn.
W. L. Breyfogle, M. D., Louisville, Ky.
Samuel Potter, M. D., Milwaukee, Wis.
F. s F. DeDerkey, M. D., Sacramento, Cal.
John C. Budlong, M. D., Providence, R. I.
J. H. Gallinger, M. D., Concord, N. H.

1882.

*R. E. Caruthers, M. D., Allegheny, Penn.
John M. Hayward, M. D., Liverpool, Eugland.
J. Giles Blake, England.
Samuel A. Jones, M. D., Ann Arbor, Mich.
George B. Peck, M. D., Providence, R. I.
O. S. Runnels, M. D., Indianapolis, Ind.

1883.

J. L. Corbin, M. D., Athens, Penn.

D. B. Whittier, M. D., Fitchburg, Mass.

W. B. Chamberlain, M. D., Worcester, Mass.

1884.
Wallace McGeorge, M. D., Woodbury, K". J.

1886.

H. C. Allen, M. D., Ann Arbor, Mich.
Elias Yernon, M. D., Hamilton, Canada.

1887.

* —

H. F. Biggar, M. D., Cleveland, Ohio.

Nominees for the Regents' Degree. 221

KOXIKBBS FOB THE REGENTS' DEGREE.

1863.
^Frederick F. Stamm, Brooklyn.

1867.
*M. M. Matthews, Rochester.

1872.

Alfred W. Gray, Milwaukee, Wis.
Caspar Bruchhausen, Norwich.
William B. Reeve, Quogue.

1875.
*Constantine Hering, Philadelphia, Penn.

1876.
*John F. Gray, New York.

1877.

*Carroll Dunham, Irvington. *H. V. Miller, Syracuse.

William EL Watson, Utica. William Gulick, Watkins.

1878.

Egbert Guernsey, New York. E. P. Fowler, New York.
Charles Sumner, Rochester. *C. Ormes, Jamestown.

1879.

A. W. Holden, Glens Falls. L. M. Pratt, Albauy.

Asa S. Couch, Fredonia. Edward Bayard, New York.

1880.

A. R. Wright, Buffalo. Henry Minton, Brooklyn.

O. Groom, Horseheads. W. C. Doane, Syracuse.

1881.

H. M. Paine, Albany. A. S. Ball, New York.

E. H. Hurd, Rochester. C. T. Harris, Syracuse.

1882.

Chas. E. Swift, Auburn. E. Darwin Jones, Albany.

1883.

John W. Dowling, New York. *L. M. Kenyon, Buffalo.

R. C. Moffat, Brooklyn. John J. Mitchell, NewburgU.

222 Senior and Permanent Members.

1884.
S. Powell Burdick, Oakland, Cal. Timothy F. Allen, New York.

1886.

Samuel Lilienthal, Cal. Everitt Hasbrouck, Brooklyn.

*Titus L. Brown, Binghamton. Edward S. Coburn, Troy.

i 1887.

Wm. Tod Helmuth, New York. Henry C. Houghton, New York.

SENIOR MEMBERS.

1885.

1863. R 0. Moffat, M. D., Brooklyn.
1865. Wm Gulick, M. D., Watkins.

1886.

1864. E. Darwin Jones, M. D., Albany,
1864. L. M. Pratt, M. D., Albany.

1887.

1864. L. B. Wells, M. D., Utica.

1863. A. S. Ball, M. D., New York.

1864. D. H. Bullard, M. D., Glens Falls.

PERMANENT MEMBERS.

Elected.

Adriance, F. W Elmira, 1883

Allen, George Water ville, 1883

Allen, T. F 10 E. 36th Street, New York, 1879

Armstrong, T. S Binghamton, 1883

Atwood, J. Freeman 307 Cumberland St., Brooklyn, 1883

Bacon, Chas. A 130 E. 35th Street, New York, 1879

Baker, C. C Batavia, 1873

Banker, Jb\ A Bhinebeck, 1887

Barnard, J. F Clyde, 1886

Barnes, W. H Chatham, 1872

Baylies, B. L' B 358 Hancock St., Brooklyn, 1883

> -hi ■■ rir~

Permanknt Members. 223

Elected.

Beach, Eliza J Waverly, 1875

Belcher, George E 522 Madison Ave., New York, 1868

Benson, E. F Troy, 1886

Biegler, J. A 58 S. Clinton Street, Rochester, 1879,

Billings, G. H Cohoes, 1875

Birdsall, S. T Glens Falls, 1883

Bishop, E. 8 Medina, 1867

Bonnell, Chas. L 3 Hanson Place, Brooklyn, 1879

Boocock, Eobert Flatbush, ' 1883

Borden, G. T Caledonia, 1887

Boyce, C. W Auburn, 1863

Bradner, Ira S Middletown, 1876

Brainard, L. L Little Falls, 1883

Brayton, S. N 202 Delaware Ave., Buffalo, 1886

Brown, E. V Tarrytown, 1886

Brown, W. B Palmyra, 1871

Bryan, E. W Corning, 1880

Bull, L. A 160 Franklin Street, Buffalo, 1886

Burdick, S. Powell Oakland, Cal. 1874

Butler, W. M 507 Clinton Ave., Brooklyn, 1881

Calkins, T. T Hudson, 1868

Campbell, Alice B 114 S. 3d Street, Brooklyn, E.D., 1882

Campbell, C. E Elmira, 1886

Candee, J. W 76 Warren Street, Syracuse, 18S5

Carr, Allen B 89 N. Clinton Street, Eochester, 1883

Carroll; S. H 228 State Street, Albany, 1874

Case, W. E Poughkeepsie, 1886

Chamberlain, Jos. H Belfast, 1887

Chapin, Edward 352 Clinton Street, Brooklyn, 1883

Chase, C. E 134^ Park Ave., Utica, 1882

Clark, A. J Bingharaton, 1883

Clark, L. A Loveland, Larimer Co., Col., 1S79

Coburn, Edward S 91 Fourth Street, Troy, 1874

Coffin, H. W 415 West 47th Street,New York, 1883

Cole, Directus D Morrisville, 1883

Collins, N. M 43 East Ave., Eochester, 1886

Cook, C. P Hudson, 1872

Cook, Joseph W 138 Delaware Avenue, Buffalo, 1883

Cornell, C. W 343 W. 29th Street, New York, 1884

Couch, Asa S Fredonia, 1864

Covert, N. B Geneva, 1878

224 Permanent Members.

Elected.

Cowl, Walter Y 162 W. 34th St., New York 1883

Cox, G. A 80 So. Swan St., Albany, 1878

Cox, J. W 109 State St., Albany, 1869

Crandall, E. L Troy, 1885

Curtiss, Alexander M 334 Pearl St., Buffalo, 1883

Day foot, Herbert M 41 Sophia St., Rochester, 1881

Decker, Wm. M Kingston, 1883

Dods, A. Wilson Fredonia, 1883

Doolittle, Jas. F Ballston Spa, 1883

Doughty, F. E. . .^ 512 Madison Ave., New York, 1877

Dowling, J. W. * 313 Madison Ave., New York, 1873

Dutcher, Merritt T Owego, 1884

Eddy, Ermina C Elmira, 1883

Elliott, J. B 493 Clinton Ave., Brooklyn, 1878

Everitt, Daniel L 39 Madison St., Brooklyn, 1867

Fancher, Edwin Middletown, 1885

Faust, Louis Schenectady, - 1885

Fiske, Wm. M. L 12 Bedford Ave., Brooklyn,E.D.,l875

Fowler, Win. P 63 So. Clinton St., Rochester, 1876

French, W. W Ballston Spa, 1883

Frve, Moses M Auburn. 1884

Fulford, G. H Henderson, 1883

Fuller, Hiram E Lansingburgh, 1885

Fulton, Fred S Ill E. 70th St., New York, 1887

Gallup, M. W Saugerties, 1883

Gamman, A. M Corning, 1886

Gifford, Barton R Madison, 1883

Gifford, G. A Clayville, 1875

Gifford, G. L Hamilton, 1868

Gifford, W. B Attica, 1886

Goewey, Catherine E 213 Hamilton "St., Albany, 1880

Gorham, Geo. E 160 Hamilton St., Albany, 1883

Grant, B. F Bath, 1874

Groves, C. A Ticonderoga, 1886

Greenleaf, J. T Owego, 1884

Guernsey, Egbert 526 Fifth Ave., New York, 1865

Guy, C. N Maine, 1885

Hale, C. D 53 Warren St., Syracuse, 1883

Hallock, Lewis 34 E. 39th St., New York, 1867

Hand, George F Binghamton, 1884

Hasbrouck, E 369 9th St., Brooklyn, J873

Permanent Membeks.

Hasbrouck, Sayer Providence, R. I.,

Hathaway, W. E Hornelleville,

Haviland, N. H Fulton,

Helrauth, William Tod 299 Madison Ave., New York,

Heinemann, J. D 77 E. Eagle St., Buffalo,

Hill, C. Jadson Utica,

Holden, A. W Glens Falls,

Houghton, B. L Greene,

Houghton, Henry C 12 "W. 39th St., New York,

Hulst,P. H Greenwich,

Hunt, D. B 44 "West 29th St., New York,

Hunting, Nelson 155 Hamilton St., Albauy,

Hurd, E. H 41 Sophia St., Rochester,

Hutchine; H. S Batavia,

Jeffrey, George C 341 Tompkins Ave., Brooklyn,

Jones, Charles E 140 State St., Albany,

Keeney, J. H Oswego,

Kellogg, E. M . . . . 134 E. 36th St., New York,

Kenyon, W. B S6 W. Mohawk St., Buffalo,

King, George H Geneva,

King, W. H 23 W. 53rd St., New York,

Kinne. A. B 29 E. Jefferson St., Syracuse,

Kinney, C. Spencer Middletown,

Knapp, Theodore P Union,

Knickerbocker, S. C Watertown,

Laird, F. F Utiea,

Laird, W. T Watertown,

Latimer, Wm. C 410J Clinton PI., Brooklyn,

Lee, J. M 89 Plymouth Ave., Rochester,

Lewis, F. Park 188 Franklin St., Buffalo,

Lewis, G. W 311 Delaware Ave., Buffalo,

Lilienthal, S , Cal.

Linendall, Robert A Fort Edward,

Little, G. W Glens Falls,

Long, William E 187 15th St., Buffalo,

Low, C. E Plattsburg,

Lozier, Clemence S 103 W. 4Sth St., New York,

McKinney, Susan S 178 Ryerson St., Brooklyn,

McKown, J. F Hamilton St., Albany,

McManus, G. D Oswego,

McMurray, Robert 234 Second Ave., New York,

226 Permanent Membebs,

Elected.

McPherson, J. C Lyons, 1883

Milbank, W. E Ill State St., Albany, 1879

Miller, E. E Oxford, 1871

Millspaugh. 0. F Binghamton, 1883

Minton, Henry 165 Joralemon St., Brooklyn, 1864

Mitchell, J. J Newburgh, 1880

Moffat, John L 17 Schermerhorn St., Brooklyn 1883

Moore, J. de Velio Utica, • 1887

Morgan, A. R New York, 1866

Mosher, Charles M Easton, 1863

Mull, P. W Ghent, 1876

Nash, E. B Cortland, 1885

Noble, G. Z Dundee, 1884

Norton, Arthur B 167 W. 34th St., New York, 1886

Norton, George S 154 W. 34th St., New York, 1884

Osborne, N 73 W. Eagle St., Buffalo, 1879

Ostrom, Homer 1 42 W. 48th St., New York, 1886

Otis, Clark Penn Yan, 1883

Otis, John C Ponghkeepsie, 1883

Paine, Henry D 136 Madison Ave., New York, 1863

Paine, Horace M 105 State St., Albany, 1864

Palmer, George B East Hamilton, 1867

Pearsall, John A Saratoga Springs, 1882

Pearsall, S. J Saratoga Springs, 1866

Peckham, J. J 123 N. Pearl St., Albany, 1881

Perrine, W. L. R *37 Montague St., Brooklyn, 1876

Peterson, O. W . , . . Waterloo, 1884

Preston, H. G 138 S. Oxford St., Brooklyn, 1875

Pritchard, G. C Phelps, 1882

Proctor, W. H Binghamton, 1884

Purdy, Mark S Corning, 1887

Radway, C. W Mexico, 1885

Rogers, E. W Crystal Springs, 1879

Schenck, H. D 247 McDonough St., Brooklyn, 1887

Searle, W. S 132 Henry St., Brooklyn, 1865

Seegar, Ferdinand 718 Lexington Ave., New York, 1887

Seeley, N. R Elmira, 1871

Seeley, William W 300 Lark Street, Albany, 1886

Seymour, G. W Westfield, 1883

Shafer, Levi Kingston, 1874

Shaw, J. C Hoosick Falls, 1885

•'Jt *v

. ■ if *

•J .

. -Cfifi
• ^

Permanent Membebs. Qjft -'^M

' Elected, . ' S3

Sheldon, Jay W 76 Warren St., Syracuse, 1885 |^

Shelton, George G 10 E. 36th St., New York, 1886 .^f

Simmons, D 97 Lee Ave., Brooklyn, 1884

Simmons, Silas S Snsquehanna, Pa., 1885

Skinner, Scott W Le Roy, 1887

Slaught, J. E Hamilton, 1883

Smith, Henry M 5th Ave.. Cor. 13th St., 1865 *

Smith, Oran W Union Springs, 1884

Smith, T. Franklin 2064 6th Ave., New York, 1871

Snyder, E. E * Binghamton, 1883

South wick, A. B Rome, 1871

South wick, D. E Ogdensburg, 1867

Spencer, Thomas D 61 South Union, Rochester, 1884

Spoor, D. E Schenectady, 1883

Stebbins, J. H • Geneva, 1871

Stiles, S. E 51 Greene Ave., Brooklyn, 1880

Stiles, Henry R Tenafly, N. J., 1885

Stobbs, Alex. V Mecklenburg, 1883

Strong, Thos. M Ward's Island, 1886 v

Stumpf, D. B 311 Elliott St., Buffalo, 1885

Sullivan, R. B 201 Madison Ave., Albany, 1884

Sumner, Charles \31 S. Clinton Street, Rochester, 1873

Sumner, Charles R 31 S. Clinton Street, Rochester, 1882

Swift, C. E Auburn, 1870

Talcott, Selden H Middletown, 1874

Terry, M. O 196 Genesee Street, Utica, 1876

Thorn, Sarah Eddy Catlin, 1884

Throop, A. P Port Gibson, 1874

Tilden, John M Peekskill, 1 883

Tracy, G. A Logan, 1883

Truman, Irving P Belmont, 1884

VanCleef, C. E Ithaca, 1883

Van Denburg, M. W Fort Edward, 1887

Vincent, F. L 47 2d Street, Troy, 1873

Voak, J. B Canandaigua, 1879

Von der Liihe, A 296 S. 5th Street, Brooklyn, E. D.,1883

Waldo, H. L West Troy, 1879

Walker, Catherine Fredonia, 1886

Walker, Charles E West Henrietta, 1887

Watson, William H Utica, 1866

Welch, C. Durant Albany, 1883

92$ Permanent and Delegat* Members.

/ Elected.

Wellman, W. I Friendship, 1879

West, James A Geneseo, 1883

White, J. Ralsey E. 128th St., New York, 1863 ;

White, Sue A 221 Genesee Street, Utica, 1883

White, T. C 44 S. Clinton Street, Kochester, 1872

White, Wm. Hanford 353 Fifth Avenue, New York, 1881

Whitney, E. J 100 Lafayette Ave., Brooklyn, 1875

Wiloox, DeWitt G 138 Delaware Ave., 1887

Williamson, A. P Middletown, 1885

Williamson, B. F Friendship, 1880

Willis, Harrison 695 Lafayette Ave., Brooklyn, 1877

Winterburn, George W 29 W. 26th Street, New York, 1885

Wolcott, E. H 96 East Avenne, Rochester, 1886 j

Wright, A. E 1 66 Franklin Street, Buffalo, 1863

Wright, Francis M Waverly, 1885

Zoller, William Fort Plain, 1883 j

Zwetsch, J. D Gowanda, 1883 j

DELEGATE KEMBEES.

N. B. Each County Society will elect ail of its delegates together
for a term of four years.

Class I.

Terms expire at the close of the annual meeting, February, 188&. * \

New York County, 24. — Drs. P. E Arcularius, 57 East 21st Street i

C. E. Beebe, 21 West 37th Street.
F. H. Boynton, 30 West 33d Street.
Edmund Carleton, 58 West 9th Street.
L. L. Danforth, 159 West 44th Street.
H. M. Dearborn, 152 West 57th Street.
Geo. M. Dillow, 102 West 43d Street.

D. B. Hunt, 44 West 29th Street.
Malcolm Leal, 52d Street and Broadway.
C. S. Macy, 117 West 12th Street.
J. H. McDougal, Tompkinsville, L. I.

E. V. Moffat, 132 West 44th Street.
N. A. Mosinan, 350 Madison Avenue.

Delegate Members. 229

^New York County Continued. — *W. E. Rounds, 34 West 36th Street.

* J. M. Schley, 1 East 42d Street.
St. Clair.Smith, 8 West 38th Street.
C. F. Sterling, Detroit, Mich.
John H. Thompson, 36 East 30th Street.
S. H. Vehslage, 313 East 18th Street.
Edwin West, 111 Washington Place
J. McE. Wetmore, 41 East 29th Street.
S. F. Wilcox, 57th Street and Broadway.

Hahnemann Hospital, 1. — Roger H. Lyon, Esq., 170 Broadway.

New York Medical College and Hospital for Women, 1 . — Amelia
Wright, M. D., 221 West 34th Street.

Class II.

Terms eocpire at the close of the annual meeting, 1889.

Albany County, 4. — *Drs. C. E. Goewey, 213 Hamilton St., Albany

*G. E. Gorham, 160 Hamilton, St., Albany
*J. J. Peckham,123 N. Pearl St., Albany

Allegany County, 1. — *Dr. B. F. Williamson, Friendship.

Broome County, 1. — *Dr. G. F. Hand, Binghamton.

Cayuga County, 2. — Drs. W. H. Curtis, Owasco.

F. E. Murphy, [Hyatt] Auburn.

Chautauqua and Cattaraugus Counties, 4.

Drs. C. P. Ailing, Bradford, Pa. D. G. Ailing, Dunkirk.
M. J. Lincoln, Olean. A. B. Rice, Panama,

Chemung County, 1. — Dr. O. Groom, Horseheads.

Chenango County, 1. — Dr. S. J. Fulton, Norwich.

Columbia County, 1. — Dr. S. E. Calkins, Athens.

Dutchess County, 2. — *Drs. W. R. Case, Poughkeepsie.

*Anna C. Howland, Poughkeepsie.

Erie County, 5. — Drs. H. Baethig, 350 Pennsylvania Street, Buffalo.

H. E. Colton, 362 Pearl Street, Buffalo. -
*J. D. C. Heinemann, 77 E. Eagle St., Buffalo.
*W. B. Kenyon, 86, W. Mohawk, St., Buffalo.
*N. Osborne, 73 W. Eagle Street, Buffalo.

Livingston County, 1. — Dr. W. W. Russell, Livonia Station.

230 Delegate Members.

Madison County, 1.*— Dr. W. E. Deuel, Chittenango.

Monroe County, 3. — Drs. W. E. Graham, Brockport.

C. E. Walker, West Henrietta.

*E. H. Wolcott, 96 East Ave., Rochester.

Montgomery County, 1. — *Dr. Wm. Zoller, Fort Plain.

Class III.

Terms expire at the close of the annual meeting, February, 1890.

Kings County,12 (Brooklyn). —

Drs. W. W. Blackman, 88 So. Oxford Street.
*Gertrude G. Bishop, 310 Throop Avenue.
J. Albro Eaton, 123 Clymer Street, E. D.
S. Eden, 91 Tompkins Avenue.

D. A. Gorton, 137 Clinton Street.
Helene S. Lassen, 96 Henry Street.

Wm. E. McCune, 109 Cumberland Street.
George Nichols, 230 Leonard Street.
A. J. Palmer, 463 Bedford Avenue.

E. H. Spooner, 776 DeKalb Avenue.
S. Talmage, 22 Schermerhorn Street.
R. K. Valentine, 65 Greene Avenue.

Niagara and Orleans Counties, 3. —

Oneida County, 3. —

Onondaga County, 3. —

Ontario and Tates Counties, 2. —

Orange County, 2. — Drs. J. W. Ostrom, Goshen.

fC. M. Lawrence, Port Jervis.

Oswego County, 2. —

♦Permanent Members.

tDeceased. . .^jg

• • ' • • •.- *■*

'*'«

Delegate Members. 231

■4

Class IV. ♦'.'I

.J A

> 'i

Terms expire at the close of the annual meeting \ February, 1691. £

Otseoo County.

Queens County. — No organization.

Rensselaer County.

Saratoga County

Schuyler County.

Seneca County.

Steuben County.

St. Lawrence County.

Tompkins County.

Ulster County.

Warren and Washington Counties. — No organization.

Wayne County, 2. — Drs D. McPherson, Palmyra.

W. H. Sweeting, Savannah.

Westchester County, 3. — Drs. Joseph Hasbrouck, Dobb's Ferry.

T. C. Fanning, Tarrytown.

INDEX.

4< tl < t

(< ft It

Address by President Houghton, ------

44 " M Paine,

Albuminuria of pregnancy —causation, W. W. Blackman, M. D.,

effects of, Wm A Allen, M. D.,
44 " " therapeutics of, Geo. W. Winterburn, M. D.,

Allen, Geo., M. D., cases of mammary tumors, -

peroxide of hydrogen in the treatment of abscess,
the purification of water, -
Allen, Wm. A , M. D., effects of the albuminuria of pregnancy, » -
An improved membrana tympani, Sayev Hasbrouck, M. D.,
Announcement of committees, -

A perplexing case of parturition, R. C. Moffat, M. D.,
A plea for the total extirpation of the cancerous uterus under conditions, A. R.

Wright, M. D.,
Appointment of censors, -------

A practical modification of Valsalva's experiment, Henry C. Houghton, M. D.

Auditing, committee on, -

Aural mucous polypi, Chas C. Boyle, M D., -

Ball, A S., M. D., placed on list of senior members,

• remarks by, - - - -

Beldin, C. A., M. D., remarks by, -

Biggar, Prof. H. F., M. D., Caesarian section, -

Boocock, Robert, M. D., resolutions offered by, -

remarks on single remedy,
lycopodium,
wiring the patella,
41 •« " " by,

Boyle, Chas. C, M. D., aural mucous polypi, -

" " " " curative effects of gelsemium in disease of the uveal

tract, ------

Bromine as an antidote for dissecting and septic wounds, M. O. Terry, M. D.,

Brown, Rev. J. W., D. D., prayer offered by,

Bull, L. A., M. D., remarks by, -..-..

Bullard, D. H., M. D., placed on list of senior members,

Butler, Wm. M., M. D., neurasthenia, -

Caesarian section, H. F. Biggar, M. D.,

Censors appointment of, -

1 * committee on, - -

4 * report of board of,
Chairman of bureaux, committee on, - - - _ _

Clark, Chas. G., M. D., biographical sketch of , -
Note. — Part II. is so indicated. Pages of Part I. have no prefix.

I t II II

II II tl- <i (I
i ( II It tl It

PAGE

- II

100

- II

173

- II

143

AX.

141

145

II 39-

171

118

- II

119

120

- II

171

145

- II

129

112

171

153

118

196

Index. 333

Climatology report of the bureau of , - - - - II 173

Clinical tests of potencies, resolution adopted by committee on, - 20
Collation given by New York County Society to State Homoeopathic Medical

Society, _-..-..- II 19

Committees announcement of, ------ - 28

Committee of arrangements, local — appointment of for semi annual meeting, 51

44 on chairman of bureaux, report of, 51

44 " legislation, report of , ------ 31

14 ' 4 President's address, report of, - - - 18,46

44 •• 4t resolution offered by, - II 8

14 4f regents' degree, report of, 49

44 '* tests of high attenuations, report of, - 48

Communication from Pennsylvania State Society, - 20

44 Drs. Helmuth, Dowling and Hills, '- - - II 4
Complications of parturition — pelvic dystocia and methods of delivery, H. J.

Pierron, M. D., - - - - - II 54

Constitution and By Laws, - - - - - - II 205

Cowl, Walter, Y., M. D., the suspension of the clothing, - - II 66

Credentials, committee on, - - - - - - 3, 28 II 3

" report of committee on, - - - 3

Curative effects of gelsemium in disease of the uveal tract, Chas. C Boyle, M.D , II 129

De ad y, Ch as., M. D., remarks by, ...... II 139

44 44 4t spectacles, ...... II 125

Deceased permanent members, - - - - -II213

Delegates, report of, ...... 47

Delegate, members, - - - - - - - -II 228

Department of necrology, - - - - - - - II183

Diplopia, a clinical case, John L. Moffat, M, D., - - - II 136

Dods, A. Wilson, H, D., microscopic anatomy of the carcinomata, - - II 178

Election of officers, -------- 50

Experience in the management and treatment of neurasthenia, George E. Gorfcam,

M. D., II 162

Extracts from case book, E. H. Linnell, M. D., - - - II 131

Gilchrist, J. G. M. D., radical cure for hernia, - - - II 97
Gorham, Geo. E., M. D., experience in the management and treatment of

neurasthenia, - - - - - II 162

44 44 * 4 remarks on the single remedy, - II 39

Gynaecology report of the bureau of, - - - - II 66

Hahnemann's writings and rubrick, M. W. VanDenburgh. M. D., - II 30

Hasbrouck, E., M. D., remarks on death of Dr. Brown, - - II 20

44 44 44 €4 monotropa, ... - II 39

Hasbrouck, Sayer, M. D., 44 lt spectacles, - - - - II 139

44 44 4I 44 gelsemiutn, .... II 140

44 * 4 t4 an improved membrana tympani, - - II 143

44 4I " remarks by, - - II 147, 149

Helmuth, Wm. Tod, M. D., nominated for regents' degree, - - - 51

Histology report of the bureau of, - - - - - II 178

Holden, A. W., M. D., report of, as necrologist, .... 47

Hollet, Arthur P., M. D., biographical sketch of, - - II 189

Honorary members, -------- II 218

ti It

• • l«

334 Index.

Houghton, Henry C, M. D., address by president, - 5. 22
" " " a practical modification of Valsalva's experiment, II 141,

*' " *' nominated for regents' degree, - 51.

remarks by, - - - 3, II 148

" " ** resolution offered by, - - - II ig

" i# ,# vote of thanks tendered, . - - - 17

Howland, Anna C, M. D., report of as delegate, ... 47

" " " resignation of, - 49

In memorium, .....-.- \{ 213

Invitations, committee on, - - - - - - - 28

Kenyom, L. M., M. D., biographical sketch of, - - - - II . 191

King, Wm H.,M. D , treatment of fibroid tumors by elect olysis, - - II 93
Knight, S. H., M. D., remarks on the before and after treatment of laparotomy, II 123

Laryngology, report of the bureau of , - - - - -II 167

Leal Malcolm, M. D , on conditions of the larynx requiring local treatment, II 169

Lee, J. M., M. D., remarks on lycopodium, - - - - II 119

antiseptics, ... - - -11121,123,124.

** before and after treatment of laparotomy - - II 122 •

supra-pubic cystotomy (clinical) - - - - II 89

Legislation, report of committee on, - - - - - -19, 31

Linnell, E. H., M. D. , extracts from case-book, - - - II i3 r

remarks by, - II 140

List of permanent members - - - - - - II 222

Local treatment of laryngeal, pharyngeal and nasal tuberculosis,

J. M Schley, M. D., - - - - - - II 167

Mammary tumor — was it scirrhous? R. C. Moffat, M. D., - - II 80

Marasmus infantum, Susan S. McKinncy, M. D., - - - - II 150

Materia medica, report of the bureau of, . - - - - - II 22

McKinney, Susan S., M. D., marasmus infantum, - - - -II 150

M c Murray, Robert M. P., remarks by, - - - - - II 39

Medical legislation, report of committee on, - - - - - 1 1 8

Medical bill, ... II 9

Medium of drug action, B. S. Partridge, M. D., - - - - - II 26

Members, list of permanent, - - - - - - - II 222

Membership, applications for, - - - - - - 20 II 20

Mental and nervous diseases, report of the bureau of, - - - - II 152

Microscopic anatomy of the carcinomata, A. Wilson Dods, M. D., - II 178

Moffat, John L., M. D., diplopia, a clinical case, - - - - II 13°

remarks on drug action, - - - - II 39

14 single remedy, - - - - II 30

Moffat, R. C, M. D., mammary tumor — was it scirrhous ? - II 80

Necrologist, report of, A. W. H olden, M. D. f - - - - 47

Necrology, department of, - - ... - II 183

Neurasthenia, William M. Butler, M. D., - - - - - - II 153

Neurasthenia and melancholia, Selden H. Talcott, M. D., - - - II 159

Nomination of candidates for regents' degree, - - - 51, II 221

Norton, A. B., M. D., remarks on colocynth, - - - II 138

" gelsemium, II 139

' Politzer's inflator, II 147

" u " " " spectacles, II 139

Nottingham. J. C, M. D., delegate from Michigan, ... ,3.

11 11 11 11

II « •« t* II i<

Index.

335

1 1

Observations on the medical and surgical treatment of tumors and cancers of the

breast, M. O. Terry. M. D. f
Obstetrics, report of the bureau of,
Officers, --------- 50,

On conditions of the larynx requiring local treatment, Malcolm Leal, M. D.,

Ophthalmology, report of the bureau of,

Ormes, Cornelius, M. D., biographical sketch of,

Ostrom, H. T., M. D., the before and after treatment of laparotomy,

the treatment of the pedicle in hysterotomy,

remarks on antiseptics, -
Otology, report of the bureau of, ----- -

Paedology, report of the bureau of, - - -

Paine. H. M., M. D., biographical sketch of, -

Partridge, B. S., M. D., the medium of drug action,

Permanent and honorary members, ------

Permanent members, list of.

Peroxide of hydrogen in the treatment of abscess, George Allen, M. D.,

Pettit, T. J., M. D., biographical sketch of, - -

Philip, Jacob S., M. D., biographical sketch of, -

Pierron, H. J., M. D., complications of parturition, -

Pratt, O. E., M. D., resignation of,

President's address, committee on,

President's address, report of committee on, - - - - -

Radical cure for hernia, J. G. Gilchrist, M. D., - - - II

Randel, Wm. Henry, M. D., biographical sketch of , - - - -II

Regents' degree, committee on ------

nomination of candidates for,

report of committee on, -

Reports (vide respective subjects*,
Resignation of Anna C. Howland, M. D., - - - - -

•• O. E. Pratt, M. D., -

Resolutions adopted by committee on clinical tests of potencies
received from New York and Kings Counties,

<«

t»

<«

«4

Schley, J. M., M. D., local treatment of laryngeal, pharyngeal, and nasal

tuberculosis, - - - - - II

'• M " remarks by. - II

Selection of time and place for semi-annual meeting, -

Semi-annual meeting at Niagara Falls, -

Senior members, L. B. Wells, M. D , placed on list of, -

A. S. Ball, M. D., "

D. H. Bullard, M. D.,
Shelton, George G., M. D., remarks by, ----- II

Smith, Henry M., M D., remarks on single remedy, - - - II

Spectacles, Charles Deady M. D. - - - - II

Statement issued by committee on legislation, - - - - -

Strong, T. M., M. D., remarks by, II

Supra-pubic cystotomy (clinical), J. M. Lee, M. D., - - - - II

Surgery, report of the bureau of, - - - - - - II

Suspension of the clothing, Walter Y. Cowl, M. D., - - - - II

4i
216

169.

125
186
104
81
122
141

150

199

222

100

184

187

193
29

5i
49

49
49
20

1 67
171

51
3

49
172

40
125

33
172

73
66

336

Index.

• I

!•

Talcott, Selden H., M. D., neurasthenia and melancholia, - II

Telegram to Pennsylvania Homoeopathic Medical Society, - - II

received from •• " I[

Terry, M. O., M. D., resolution offered by, - - - - - II

remarks by, - - - - II 143, 172

observations on the medical and surgical treatment of

tumors and cancers of the breast, - - - 1 1

bromine as an antidote for dissecting and septic wounds, II
Tests of high attenuations, report of committee on, - -

Thanks, vote of, tendered Dr. Paine, - -

Thanks, vote of, tendered proprietors of Cataract House, -

President Houghton, -

Secretary H. M. Day foot,

Members ot the common council of the city of Albany
New York County Horn Med. Society, - II

The before and after treatment of laparotomy, H. I. Ostrom, M. D , - II

The indicated remedy, E. H. Wolcott. M. D., - - - - II

The single remedy, " " " II

The suspension of the clothing, Walter Y. Cowl, M. D., - II

The treatment of the pedicle in hysterotomy, H. I. Ostrom, M. D., - - II

Thirty-sixth annual meeting, proceedings of, -

Transactions, set of granted Hahn. Society of Horn. Med. College, New York, -
Treasurer, report of, - -

Treatment of fibroid tumors by electrolysis— Dr. Apostoli's method, William H.

King, M.D., - - - - - - - II

Van Denburg, M. W., M. D., Hahnemann's writings and rubrick - - II

remarks on colocynth, - - II

lyco] odium, - - - II

single remedy, - II

Vote of thanks tendered Dr. Paine, ------

" " " Proprietors Cataract House,

President Houghton, -

Secretary H. M. Dayfoot, -

Members common council of city of Albany,

New York County Horn. Med. Society, - II

Wells, L. B., M. D., placed on list of senior members, -
Wilcox, Sidney F., M. D., wiring the patella, - - - - II

44 44 " remarks on radical cure for hernia, - - II

41 " " " wiring the patella, II

antiseptics, - - - - II

the before and after treatment of laparotomy, II
Winterburn, Geo. W., M. D., Albuminuria of, pregnancy — the therapeutics of, II
Wiring the patella Sidney F. Wilcox, M. D., - - - - II

Wolcott, E. H.,M. D., the indicated remedy, - - - II

" *' " the single remedy, - - - - - II

Wright, A. R., M. D., a plea for the total extirpation of the cancerous uterus

under conditions, - - - - - - - - II 70

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159
4
8

73
112

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5i

51
21
104
22
28
66
81
22

51
30

30
138
119

38
20
21

51
21

49
113

119

120

121

122

113
22

1 /

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